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General NPI Number Information
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NPI Number | 1497949408
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Entity Type | Organization
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Legal Business Name | SHARP VISION INC
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Dates
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Enumeration Date | 09/02/2007
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Last Update Date | 11/11/2008
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Provider Practice Location Address
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Address Line | 2126A S ARCHER AVE
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City | CHICAGO
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State | IL
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Zip | 60616-1514
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Country | US
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Telephone | 312-949-1888
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Fax |
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Provider Business Mailing Address
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Address Line | 2126A S ARCHER AVE
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City | CHICAGO
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State | IL
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Zip | 60616-1514
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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 | WALLACE W CHAN
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Credential | OD
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Telephone | 312-949-1888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | 24236918
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License Number State | IL
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