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General NPI Number Information
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NPI Number | 1871970715
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Entity Type | Organization
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Legal Business Name | OPTICAL PRO, INC
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Dates
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Enumeration Date | 04/29/2015
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Last Update Date | 04/29/2015
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Provider Practice Location Address
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Address Line | 1525 OGDEN AVE SUITE C
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City | DOWNERS GROVE
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State | IL
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Zip | 60515-2776
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Country | US
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Telephone | 630-963-3260
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Fax |
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Provider Business Mailing Address
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Address Line | 1525 OGDEN AVE SUITE C
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City | DOWNERS GROVE
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State | IL
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Zip | 60515-2776
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Country | US
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Telephone | 630-963-3260
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MAGDY MINA
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Credential |
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Telephone | 630-963-3260
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | 13-ACM-0096
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License Number State | IL
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