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General NPI Number Information
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NPI Number | 1285804369
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Entity Type | Organization
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Legal Business Name | EDDY SKOKIE OPTICAL INC
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Dates
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Enumeration Date | 03/05/2008
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Last Update Date | 10/31/2008
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Provider Practice Location Address
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Address Line | 8035 N LINCOLN AVE
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City | SKOKIE
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State | IL
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Zip | 60077-3612
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Country | US
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Telephone | 847-679-1775
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Fax | 847-679-4231
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Provider Business Mailing Address
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Address Line | 8035 N LINCOLN AVE
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City | SKOKIE
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State | IL
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Zip | 60077-3612
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Country | US
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Telephone | 847-679-1775
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Fax | 847-679-4231
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Authorized Official
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Title or Position | OPTICIAN
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Name | MISS EDGARD LEGUIZAMON
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Credential |
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Telephone | 847-679-1775
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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 | 047928740
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License Number State | IL
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