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General NPI Number Information
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NPI Number | 1760012645
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Entity Type | Organization
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Legal Business Name | PRICE OPTICAL VISION SPECIALISTS LLC
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Dates
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Enumeration Date | 01/20/2020
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Last Update Date | 03/09/2020
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Provider Practice Location Address
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Address Line | 8541 S COTTAGE GROVE AVE
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City | CHICAGO
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State | IL
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Zip | 60619-6115
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Country | US
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Telephone | 773-651-7106
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Fax |
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Provider Business Mailing Address
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Address Line | 8541 S COTTAGE GROVE AVE
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City | CHICAGO
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State | IL
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Zip | 60619-6115
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Country | US
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Telephone | 773-651-7106
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. CALVIN VANCE III
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Credential | OD
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Telephone | 773-474-6673
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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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