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General NPI Number Information
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NPI Number | 1275616013
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Entity Type | Organization
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Legal Business Name | SMART OPTICAL
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2349 S. WENTWORTH AVE
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City | CHICAGO
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State | IL
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Zip | 60616
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Country | US
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Telephone | 312-808-1893
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Fax | 312-808-1834
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Provider Business Mailing Address
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Address Line | 2349 S. WENTWORTH AVENUE
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City | CHICAGO
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State | IL
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Zip | 60616
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Country | US
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Telephone | 312-808-1893
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Fax | 312-808-1834
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Authorized Official
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Title or Position | OPTICIAN
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Name | MR. SHUI MAN WONG
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Credential |
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Telephone | 312-808-1893
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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 |
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License Number State | IL
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