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General NPI Number Information
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NPI Number | 1386884575
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Entity Type | Organization
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Legal Business Name | KORNEAL KONTAX
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Dates
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Enumeration Date | 02/27/2009
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Last Update Date | 02/27/2009
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Provider Practice Location Address
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Address Line | 9928 S WESTERN AVE
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City | CHICAGO
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State | IL
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Zip | 60643-1831
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Country | US
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Telephone | 773-238-7450
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Fax | 773-238-6487
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Provider Business Mailing Address
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Address Line | 9928 S WESTERN AVE
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City | CHICAGO
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State | IL
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Zip | 60643-1831
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Country | US
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Telephone | 773-238-7450
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Fax | 773-238-6487
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Authorized Official
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Title or Position | SECRETARY TREASURER
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Name | MR. JOSEPH G GREENBERG
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Credential |
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Telephone | 773-238-7450
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | IN
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