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General NPI Number Information
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NPI Number | 1962973503
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Entity Type | Organization
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Legal Business Name | SOLO EYE CARE BRIDGEPORT LLC
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Dates
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Enumeration Date | 12/07/2018
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Last Update Date | 05/02/2025
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Provider Practice Location Address
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Address Line | 3460 S HALSTED ST
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City | CHICAGO
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State | IL
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Zip | 60608-6743
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Country | US
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Telephone | 313-225-5135
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Fax | 312-225-5309
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Provider Business Mailing Address
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Address Line | 3460 S HALSTED ST
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City | CHICAGO
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State | IL
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Zip | 60608-6743
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Country | US
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Telephone | 312-225-5135
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Fax | 312-225-5309
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JENIFER PANKOW
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Credential |
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Telephone | 708-704-1890
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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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Taxonomy #2
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number |
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License Number State |
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