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NPI Code Detail

MEDICARE: ELITE OPTICAL LOOK DBA PEARLE VISON

MEDICARE: ELITE OPTICAL LOOK DBA PEARLE VISON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1332H00000XEyewear Supplier1817003IL

General Provider Information

NPI Number : 1023229440
Entity Type Code : Organization
Provider Name (Legal Business Name) : ELITE OPTICAL LOOK DBA PEARLE VISON
Provider Business Mailing Address
First Line : 410 N MICHIGAN AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60611-4213
Country : US
Telephone Number : 312-644-0885
Fax Number : 312-222-1127
Provider Business Practice Location Address
First Line : 410 N MICHIGAN AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60611-4213
Country : US
Telephone Number : 312-644-0885
Fax Number : 312-222-1127
Authorized Official
Title or Position : OWNER
Name : MRS. GINA LIGHT
Credential :
Telephone Number : 312-644-0885
Provider Enumeration Date : 05/25/2007
Last Update Date : 09/07/2007

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Directions to “ELITE OPTICAL LOOK DBA PEARLE VISON ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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