| NPI | 1982005260 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RENEE RUSSO Administrator 312-350-8269 |
| Organization Subpart ? | No |
| Primary Taxonomy | 156FX1202X Technician/Technologist, Optometric Technician |
| Additional Taxonomies | 302R00000X Health Maintenance Organization |
| Enumeration Date | 2014-09-05 |
| Last Update Date | 2014-09-05 |