Lincoln Square Optical
Optometrist in Chicago, IL. Organization (NPI-2).
NPI number1346716768
StatusActive
Last updated in NPPESOct 23, 2018
Details
- NPI
- 1346716768
- Entity type
- Organization (NPI-2)
- Legal business name
- Lincoln Square Optical
- Organization subpart
- No
- Enumeration date
- Oct 23, 2018
- Last updated
- Oct 23, 2018
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 152W00000X | Optometrist | – | – | Yes |
| 152WC0802X | Optometrist, Corneal and Contact Management | – | – | |
| 152WL0500X | Optometrist, Low Vision Rehabilitation | – | – | |
| 152WP0200X | Optometrist, Pediatrics | – | – | |
| 152WV0400X | Optometrist, Vision Therapy | – | – |
Practice location
2501 W Lawrence AveChicago, IL 60625-2958
Phone 773-931-3839
Mailing address
5232 Wright TerSkokie, IL 60077-2161
Phone 773-931-3839
Authorized official
Mariam Ethezaz
Optometrist
7739313839
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