Full Name | |
---|---|
Type | Facility |
Speciality | Eyewear Supplier |
Location | 9940 Rt 47, Huntley, Illinois |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1710512801 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | (* (Not Available)) | Secondary |
332H00000X | Eyewear Supplier | (* (Not Available)) | Primary |
Mailing Address | Practice Location Address |
---|---|
Po Box 19060, Green Bay, WI 54307-9060 Ph: (920) 429-7842 | 9940 Rt 47, Huntley, IL 60142 Ph: (847) 802-8788 |