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General NPI Number Information
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NPI Number | 1639410830
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Entity Type | Organization
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Legal Business Name | BELMONT EYECARE LLC
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Dates
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Enumeration Date | 03/13/2013
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Last Update Date | 04/21/2015
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Provider Practice Location Address
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Address Line | 3110 W BELMONT AVE UNIT 1E
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City | CHICAGO
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State | IL
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Zip | 60618-5788
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Country | US
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Telephone | 312-217-9563
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Fax | 312-488-2643
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Provider Business Mailing Address
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Address Line | 3110 W BELMONT AVE UNIT 1E
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City | CHICAGO
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State | IL
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Zip | 60618-5788
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Country | US
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Telephone | 312-217-9563
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Fax | 312-626-2398
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Authorized Official
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Title or Position | DOCTOR OF OPTOMETRY
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Name | DR. GOLIE ROSHANDEL KEOVAN
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Credential | O.D.
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Telephone | 312-217-9563
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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 |
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