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NPI Code Detail

MEDICARE: EDENS OPTICIANS, INC.

MEDICARE: EDENS OPTICIANS, INC.
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 Supplier

General Provider Information

NPI Number : 1316168727
Entity Type Code : Organization
Provider Name (Legal Business Name) : EDENS OPTICIANS, INC.
Provider Business Mailing Address
First Line : 5569 W 95TH ST
Second Line :
City : OAK LAWN
State : IL
Zip : 60453-2356
Country : US
Telephone Number : 708-499-3656
Fax Number : 773-238-5277
Provider Business Practice Location Address
First Line : 5569 W 95TH ST
Second Line :
City : OAK LAWN
State : IL
Zip : 60453-2356
Country : US
Telephone Number : 708-499-3656
Fax Number : 773-238-5277
Authorized Official
Title or Position : OWNER
Name : MR. HARRY L. EDENS JR.
Credential :
Telephone Number : 708-499-3656
Provider Enumeration Date : 05/01/2007
Last Update Date : 01/11/2008

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