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General NPI Number Information
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NPI Number | 1265767065
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Entity Type | Organization
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Legal Business Name | LOOKSMART OPTICAL IL, LLC
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Dates
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Enumeration Date | 10/12/2009
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Last Update Date | 10/12/2009
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Provider Practice Location Address
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Address Line | 2781 MAPLE AVE
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City | LISLE
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State | IL
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Zip | 60532-3280
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Country | US
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Telephone | 630-904-6000
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Fax | 630-904-6008
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Provider Business Mailing Address
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Address Line | 2781 MAPLE AVE
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City | LISLE
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State | IL
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Zip | 60532-3280
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Country | US
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Telephone | 630-904-6000
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Fax | 630-904-6008
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | MR. RENZO LUZZATTI
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Credential |
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Telephone | 954-275-6490
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 044008712
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License Number State | IL
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