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General NPI Number Information
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NPI Number | 1952839599
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Entity Type | Organization
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Legal Business Name | WINITZ OPTICAL INC.
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Dates
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Enumeration Date | 05/26/2017
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Last Update Date | 08/07/2017
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Provider Practice Location Address
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Address Line | 4151 W PETERSON AVE
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City | CHICAGO
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State | IL
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Zip | 60646-6002
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Country | US
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Telephone | 773-685-5606
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Fax |
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Provider Business Mailing Address
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Address Line | 4151 W PETERSON AVE
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City | CHICAGO
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State | IL
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Zip | 60646-6002
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST/PARTNER
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Name | ALEXIS SCATCHELL
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Credential | OD
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Telephone | 773-458-3230
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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 | 046009919
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License Number State | IL
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