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General NPI Number Information
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NPI Number | 1386965838
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Entity Type | Organization
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Legal Business Name | BIRCH OPTICAL
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Dates
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Enumeration Date | 06/18/2010
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Last Update Date | 06/18/2010
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Provider Practice Location Address
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Address Line | 5493 N. MILWAUKEE AVE.
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City | CHICAGO
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State | IL
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Zip | 60630-1249
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Country | US
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Telephone | 773-775-3300
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Fax | 773-775-3313
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Provider Business Mailing Address
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Address Line | 5493 N MILWAUKEE AVE
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City | CHICAGO
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State | IL
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Zip | 60630-1249
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Country | US
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Telephone | 773-775-3300
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Fax | 773-775-3313
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Authorized Official
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Title or Position | PRESIDENT/OPTICIAN
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Name | MR. PAUL D. BIRCH
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Credential |
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Telephone | 773-775-3300
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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 |
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