Provider Demographics
NPI:1023184165
Name:UHLMENN OPTICAL OF ILLINOIS, INC.
Entity Type:Organization
Organization Name:UHLMENN OPTICAL OF ILLINOIS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:IWINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:1630-585-6100
Mailing Address - Street 1:100 W RANDOLPH ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-3218
Mailing Address - Country:US
Mailing Address - Phone:131-226-3490
Mailing Address - Fax:131-226-3493
Practice Address - Street 1:100 W RANDOLPH ST
Practice Address - Street 2:SUITE 104
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-3218
Practice Address - Country:US
Practice Address - Phone:131-226-3490
Practice Address - Fax:131-226-3493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
156FX1800X
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
Not Answered152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL204976Medicare ID - Type UnspecifiedMEDICARE PART B
ILU94221Medicare UPIN