=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871867697
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | A&A VISION INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/24/2012
-----------------------------------------------------
Last Update Date | 01/16/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 603 MADISON ST
-----------------------------------------------------
City | OAK PARK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60302-4437
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-383-2150
-----------------------------------------------------
Fax | 708-383-2553
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 603 MADISON ST
-----------------------------------------------------
City | OAK PARK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60302-4437
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-383-2150
-----------------------------------------------------
Fax | 708-383-2553
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ALEX TAN
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 708-383-2150
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 046009172
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------