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General NPI Number Information
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NPI Number | 1649760174
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Entity Type | Organization
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Legal Business Name | GOBLE VISION CARE LLC
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Dates
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Enumeration Date | 05/10/2018
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Last Update Date | 02/04/2020
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Provider Practice Location Address
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Address Line | 2475 N LINCOLN AVE
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City | CHICAGO
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State | IL
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Zip | 60614-2414
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Country | US
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Telephone | 872-829-2020
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Fax | 773-770-3497
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Provider Business Mailing Address
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Address Line | 2475 N LINCOLN AVE
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City | CHICAGO
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State | IL
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Zip | 60614-2414
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Country | US
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Telephone | 872-829-2020
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Fax | 773-770-3497
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Authorized Official
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Title or Position | OWNER
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Name | GRANT WILLIAM GOBLE
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Credential |
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Telephone | 872-829-2020
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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 | 046010585
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License Number State | IL
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