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General NPI Number Information
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NPI Number | 1740203850
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Entity Type | Organization
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Legal Business Name | OSWEGO VISION, LTD
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Dates
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Enumeration Date | 07/26/2006
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Last Update Date | 01/23/2009
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Provider Practice Location Address
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Address Line | 83 TEMPLETON DR SUITE F
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City | OSWEGO
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State | IL
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Zip | 60543-7019
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Country | US
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Telephone | 630-554-8002
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Fax | 630-554-8095
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Provider Business Mailing Address
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Address Line | 83 TEMPLETON DR SUITE F
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City | OSWEGO
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State | IL
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Zip | 60543-7019
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Country | US
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Telephone | 630-554-8002
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Fax | 630-554-8095
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Authorized Official
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Title or Position | OWNER
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Name | ALAN E. HEIN
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Credential | OD
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Telephone | 630-554-8002
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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 | 046008044
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License Number State | IL
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