| NPI | 1962973503 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER E PANKOW General Manager 312-588-5999 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 152WC0802X Optometrist, Corneal and Contact Management |
| Enumeration Date | 2018-12-07 |
| Last Update Date | 2021-03-02 |