| NPI | 1417130543 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WALTER ATKENSON Officer 708-499-3911 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IL 46007555) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 46007528) |
| 152WC0802X Optometrist Corneal and Contact Management (Licence: IL 46007528) | |
| 152WC0802X Optometrist Corneal and Contact Management (Licence: IL 46007555) | |
| Enumeration Date | 2007-12-12 |
| Last Update Date | 2012-10-11 |