Provider Demographics
NPI:1013206531
Name:GITTELE OPTICAL INC.
Entity Type:Organization
Organization Name:GITTELE OPTICAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EUGENIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMAZOV
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:847-322-9613
Mailing Address - Street 1:3455A DEMPSTER ST
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-2455
Mailing Address - Country:US
Mailing Address - Phone:847-322-9613
Mailing Address - Fax:847-368-9920
Practice Address - Street 1:3455A DEMPSTER ST
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-2455
Practice Address - Country:US
Practice Address - Phone:847-322-9613
Practice Address - Fax:847-368-9920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-05
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046008934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty