Provider Demographics
NPI:1043330095
Name:PLYAM OF MCHENRY
Entity Type:Organization
Organization Name:PLYAM OF MCHENRY
Other - Org Name:PEARLE VISION MCHENRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GROUP MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TATYANA
Authorized Official - Middle Name:
Authorized Official - Last Name:LALAYAN
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:847-832-0073
Mailing Address - Street 1:1805 N RICHMOND RD
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-1415
Mailing Address - Country:US
Mailing Address - Phone:815-363-1700
Mailing Address - Fax:815-363-1765
Practice Address - Street 1:1805 N RICHMOND RD
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-1415
Practice Address - Country:US
Practice Address - Phone:815-363-1700
Practice Address - Fax:815-363-1765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty