Provider Demographics
NPI:1093379877
Name:EYE Q OPTIQUE AT IMD, INC.
Entity Type:Organization
Organization Name:EYE Q OPTIQUE AT IMD, INC.
Other - Org Name:EYE Q OPTIQUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:NARMINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUSEYNOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-404-7647
Mailing Address - Street 1:722 S BUFFALO GROVE RD
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-3708
Mailing Address - Country:US
Mailing Address - Phone:847-404-7647
Mailing Address - Fax:847-589-1375
Practice Address - Street 1:709 S. SEELEY AVE.
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612
Practice Address - Country:US
Practice Address - Phone:312-872-0201
Practice Address - Fax:847-589-1375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-26
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty