Provider Demographics
NPI:1215190384
Name:PULASKI VISION CENTER LLC
Entity Type:Organization
Organization Name:PULASKI VISION CENTER LLC
Other - Org Name:PEARLE VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:773-284-9844
Mailing Address - Street 1:5153 S PULASKI RD UNIT B
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60632-4219
Mailing Address - Country:US
Mailing Address - Phone:773-284-9844
Mailing Address - Fax:773-284-9862
Practice Address - Street 1:5153 S PULASKI RD UNIT B
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60632-4219
Practice Address - Country:US
Practice Address - Phone:773-284-9844
Practice Address - Fax:773-284-9862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-08
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046009715152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty