Provider Demographics
NPI:1326161506
Name:PRISM OPTICS, INC.
Entity Type:Organization
Organization Name:PRISM OPTICS, INC.
Other - Org Name:PRISM OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:BECERRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-205-6447
Mailing Address - Street 1:3594 N MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-3959
Mailing Address - Country:US
Mailing Address - Phone:773-205-6210
Mailing Address - Fax:773-205-6487
Practice Address - Street 1:3594 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-3959
Practice Address - Country:US
Practice Address - Phone:773-205-6210
Practice Address - Fax:773-205-6487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier