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General NPI Number Information
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NPI Number | 1518206721
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Entity Type | Organization
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Legal Business Name | M LAB INC.
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Dates
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Enumeration Date | 02/07/2013
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Last Update Date | 11/14/2013
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Provider Practice Location Address
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Address Line | 100 MAIN ST UNIT 2
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City | WEST CHICAGO
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State | IL
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Zip | 60185-2835
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Country | US
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Telephone | 630-293-1800
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Fax | 630-293-1801
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Provider Business Mailing Address
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Address Line | 100 MAIN ST UNIT 2
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City | WEST CHICAGO
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State | IL
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Zip | 60185-2835
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Country | US
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Telephone | 630-293-1800
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Fax | 630-293-1801
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LAWRENCE M MAGEE
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Credential | OD
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Telephone | 630-650-1285
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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 | 046008130
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License Number State | IL
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