Provider Demographics
NPI:1275716029
Name:WHALEN OPTICAL LABS INC
Entity Type:Organization
Organization Name:WHALEN OPTICAL LABS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLAIMS ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:REINGOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-399-0599
Mailing Address - Street 1:5970 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61108-2430
Mailing Address - Country:US
Mailing Address - Phone:815-395-1820
Mailing Address - Fax:815-395-9135
Practice Address - Street 1:5970 E STATE ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2430
Practice Address - Country:US
Practice Address - Phone:815-395-1820
Practice Address - Fax:815-395-9135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-14
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0148350001Medicare NSC