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General NPI Number Information
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NPI Number | 1639218357
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Entity Type | Organization
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Legal Business Name | MARS OPTICAL GROUP INC
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 18234 HALSTED ST
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City | HOMEWOOD
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State | IL
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Zip | 60430-2508
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Country | US
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Telephone | 709-798-7711
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Fax | 708-798-1349
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Provider Business Mailing Address
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Address Line | 1741 PINEHURST LN
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City | FLOSSMOOR
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State | IL
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Zip | 60422-1964
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Country | US
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Telephone | 708-799-0920
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Fax | 708-798-1349
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARK B BUSCH
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Credential | OD
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Telephone | 708-798-7711
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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 |
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License Number State | IL
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