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General NPI Number Information
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NPI Number | 1407227341
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Entity Type | Organization
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Legal Business Name | NORWOOD PARK EYE CENTER, LLC
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Dates
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Enumeration Date | 10/19/2015
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Last Update Date | 10/19/2015
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Provider Practice Location Address
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Address Line | 6107 N NORTHWEST HWY
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City | CHICAGO
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State | IL
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Zip | 60631-2127
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Country | US
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Telephone | 773-315-8372
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Fax |
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Provider Business Mailing Address
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Address Line | 6107 N NORTHWEST HWY
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City | CHICAGO
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State | IL
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Zip | 60631-2127
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Country | US
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Telephone | 773-315-8372
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DOMINICK OPITZ
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Credential | O.D.
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Telephone | 708-217-1791
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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 | O46008976
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License Number State | IL
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