Provider Demographics
NPI:1326181512
Name:THE OPTICAL PLACE LTD
Entity Type:Organization
Organization Name:THE OPTICAL PLACE LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:HINES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:773-838-8245
Mailing Address - Street 1:4401 W 63RD ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60629-5530
Mailing Address - Country:US
Mailing Address - Phone:773-838-8245
Mailing Address - Fax:773-284-8746
Practice Address - Street 1:4401 W 63RD ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-5530
Practice Address - Country:US
Practice Address - Phone:773-838-8245
Practice Address - Fax:773-284-8746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL047-047825152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL3373Medicare PIN