| Granville Vision Center | |
|
1108 W Granville Ave Chicago IL 60660-2013 | |
| (773) 465-6660 | |
| (773) 274-8222 |
| Full Name | Granville Vision Center |
|---|---|
| Speciality | Clinic/center |
| Location | 1108 W Granville Ave, Chicago, Illinois |
| Authorized Official Name and Position | Ernest Isamu Watanabe (PRESIDENT) |
| Authorized Official Contact | 7734656660 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Granville Vision Center 1108 W Granville Ave Chicago IL 60660-2013 Ph: (773) 465-6660 | Granville Vision Center 1108 W Granville Ave Chicago IL 60660-2013 Ph: (773) 465-6660 |
| NPI Number | 1285818120 |
|---|---|
| Provider Enumeration Date | 12/27/2007 |
| Last Update Date | 09/09/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285818120 | NPI | - | NPPES |
| 046006692 | Other | IL | IL STATE LICENSE |
| 1053488569 | Other | INDIVIDUAL NPI # |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 046006692 (Illinois) | Primary |
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