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General NPI Number Information
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NPI Number | 1376844076
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Entity Type | Organization
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Legal Business Name | IMS SERVICES INC
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Dates
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Enumeration Date | 11/11/2010
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Last Update Date | 11/11/2010
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Provider Practice Location Address
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Address Line | 2424 W JEFFERSON ST
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City | JOLIET
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State | IL
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Zip | 60435-6429
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Country | US
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Telephone | 815-730-9395
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Fax |
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Provider Business Mailing Address
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Address Line | 16533 W SPLIT RAIL DR
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City | LOCKPORT
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State | IL
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Zip | 60441-4691
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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 | PRESIDENT
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Name | DR. MARLIN KHOURI-LOTZ
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Credential | OD
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Telephone | 773-671-6279
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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 | 046009278
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License Number State | IL
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