=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265653489
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BEMARK, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/02/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6560 W FULLERTON AVE SUITE C-118, PEARLE VISION
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60707-3439
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-745-1767
-----------------------------------------------------
Fax | 773-745-0127
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6560 W FULLERTON AVE SUITE C-118, PEARLE VISION
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60707-3439
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-745-1767
-----------------------------------------------------
Fax | 773-745-0127
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FRANCHISEE
-----------------------------------------------------
Name | MR. JOSHUA ZAVELOVICH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 773-745-1767
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332H00000X
-----------------------------------------------------
Taxonomy Name | Eyewear Supplier
-----------------------------------------------------
License Number | 1610-4625
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------