Provider Demographics
NPI:1053506550
Name:MHAC OPTICAL
Entity Type:Organization
Organization Name:MHAC OPTICAL
Other - Org Name:AFFINITY OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JULIET
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:773-202-0181
Mailing Address - Street 1:6500 W IRVING PARK RD
Mailing Address - Street 2:SUITE I
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-2454
Mailing Address - Country:US
Mailing Address - Phone:773-202-0181
Mailing Address - Fax:773-202-0189
Practice Address - Street 1:6500 W IRVING PARK RD
Practice Address - Street 2:SUITE I
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-2454
Practice Address - Country:US
Practice Address - Phone:773-202-0181
Practice Address - Fax:773-202-0189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-09
Last Update Date:2007-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty