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General NPI Number Information
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NPI Number | 1528303435
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Entity Type | Organization
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Legal Business Name | WINDY CITY EYES PC
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Dates
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Enumeration Date | 12/04/2012
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Last Update Date | 12/04/2012
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Provider Practice Location Address
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Address Line | 6560 W FULLERTON AVE
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City | CHICAGO
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State | IL
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Zip | 60707-3439
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Country | US
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Telephone | 773-745-1768
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Fax | 773-745-0127
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Provider Business Mailing Address
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Address Line | 6560 W FULLERTON AVE
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City | CHICAGO
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State | IL
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Zip | 60707-3439
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Country | US
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Telephone | 773-745-1768
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Fax | 773-745-0127
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ADALINA KULBAK
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Credential | OD
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Telephone | 773-745-0127
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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 | 046008697
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License Number State | IL
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