Provider Demographics
NPI:1033585252
Name:GOOD VISION OPTOMETRY, LLC
Entity Type:Organization
Organization Name:GOOD VISION OPTOMETRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:J
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:706-483-6242
Mailing Address - Street 1:1 OAKBROOK CTR
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1809
Mailing Address - Country:US
Mailing Address - Phone:630-368-1101
Mailing Address - Fax:630-368-1095
Practice Address - Street 1:1 OAKBROOK CTR
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1809
Practice Address - Country:US
Practice Address - Phone:630-368-1101
Practice Address - Fax:630-368-1095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-12
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046010835152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty