Provider Demographics
NPI:1104021179
Name:EAGLE OPTICAL, INC.
Entity Type:Organization
Organization Name:EAGLE OPTICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:NOVAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-474-3500
Mailing Address - Street 1:2755 INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:IL
Mailing Address - Zip Code:60438-2225
Mailing Address - Country:US
Mailing Address - Phone:708-474-3500
Mailing Address - Fax:708-474-3556
Practice Address - Street 1:2755 INDIANA AVE
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:IL
Practice Address - Zip Code:60438-2225
Practice Address - Country:US
Practice Address - Phone:708-474-3500
Practice Address - Fax:708-474-3556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier