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General NPI Number Information
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NPI Number | 1356117501
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Entity Type | Organization
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Legal Business Name | OGDEN VISON CENTER LLC
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Dates
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Enumeration Date | 11/29/2023
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Last Update Date | 11/29/2023
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Provider Practice Location Address
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Address Line | 941 OGDEN AVE
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City | DOWNERS GROVE
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State | IL
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Zip | 60515-2828
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Country | US
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Telephone | 708-482-7744
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Fax |
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Provider Business Mailing Address
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Address Line | 5501 W PLAINFIELD RD
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City | COUNTRYSIDE
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State | IL
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Zip | 60525-3591
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | SAMIR PATEL
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Credential | OD
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Telephone | 708-482-7744
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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 |
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