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General NPI Number Information
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NPI Number | 1386192219
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Entity Type | Organization
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Legal Business Name | LUMEN OPTICAL ILLINOIS 2, LLC
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Dates
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Enumeration Date | 09/20/2016
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Last Update Date | 09/20/2016
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Provider Practice Location Address
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Address Line | 809 CHURCH ST
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City | EVANSTON
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State | IL
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Zip | 60201-3706
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Country | US
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Telephone | 801-316-5508
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Fax |
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Provider Business Mailing Address
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Address Line | 809 CHURCH ST
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City | EVANSTON
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State | IL
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Zip | 60201-3706
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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 | PRIVACY OFFICER
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Name | HEATHER ALLEN
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Credential |
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Telephone | 801-316-5508
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WP0200X
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Taxonomy Name | Pediatric Optometrist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 152WV0400X
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Taxonomy Name | Vision Therapy Optometrist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 152WX0102X
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Taxonomy Name | Occupational Vision Optometrist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 156F00000X
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Taxonomy Name | Technician/Technologist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 156FC0800X
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Taxonomy Name | Contact Lens Technician/Technologist
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 156FC0801X
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Taxonomy Name | Contact Lens Fitter
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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Taxonomy #9
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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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