Provider Demographics
NPI:1043525066
Name:MODERN OPTICAL INTERNATIONAL
Entity Type:Organization
Organization Name:MODERN OPTICAL INTERNATIONAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KEN
Authorized Official - Middle Name:
Authorized Official - Last Name:WEISSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-350-7707
Mailing Address - Street 1:585 CONGRESS CIR N
Mailing Address - Street 2:
Mailing Address - City:ROSELLE
Mailing Address - State:IL
Mailing Address - Zip Code:60172-3905
Mailing Address - Country:US
Mailing Address - Phone:630-350-7707
Mailing Address - Fax:630-350-7715
Practice Address - Street 1:585 CONGRESS CIR N
Practice Address - Street 2:
Practice Address - City:ROSELLE
Practice Address - State:IL
Practice Address - Zip Code:60172-3905
Practice Address - Country:US
Practice Address - Phone:630-350-7707
Practice Address - Fax:630-350-7715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-13
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier