Provider Demographics
NPI:1326168378
Name:PLYAM OF CHICAGO RIDGE
Entity Type:Organization
Organization Name:PLYAM OF CHICAGO RIDGE
Other - Org Name:PEARLE VISION OF CHICAGO RIDGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GROUP MANAGER OF PEARLE VISION
Authorized Official - Prefix:MS
Authorized Official - First Name:TATYANA
Authorized Official - Middle Name:
Authorized Official - Last Name:LALAYAN
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:847-832-0073
Mailing Address - Street 1:2305 WILLOW RD
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-7637
Mailing Address - Country:US
Mailing Address - Phone:847-832-0073
Mailing Address - Fax:847-832-0074
Practice Address - Street 1:220 CHICAGO RIDGE MALL
Practice Address - Street 2:
Practice Address - City:CHICAGO RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60415-2636
Practice Address - Country:US
Practice Address - Phone:708-636-5684
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty