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NPI Code Detail

MEDICARE: INTERNATIONAL MISSIONS ALLIANCE

MEDICARE: INTERNATIONAL MISSIONS ALLIANCE
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

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1152W00000XOTHERILOPTICAL DISPENSING (TAXONOMY)

General Provider Information

NPI Number : 1649433442
Entity Type Code : Organization
Provider Name (Legal Business Name) : INTERNATIONAL MISSIONS ALLIANCE
Provider Business Mailing Address
First Line : 2880 N MILWAUKEE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60618-7413
Country : US
Telephone Number : 773-252-5115
Fax Number :
Provider Business Practice Location Address
First Line : 2880 N MILWAUKEE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60618-7413
Country : US
Telephone Number : 773-252-5115
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : MR. PETRU AMAREI
Credential :
Telephone Number : 773-252-5115
Provider Enumeration Date : 07/02/2008
Last Update Date : 07/02/2008

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Directions to “INTERNATIONAL MISSIONS ALLIANCE ” Practice Location

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