Provider Demographics
NPI:1346377991
Name:ALAN OPTICAL, LTD
Entity Type:Organization
Organization Name:ALAN OPTICAL, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:MIHALY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:847-459-9119
Mailing Address - Street 1:400 W DUNDEE RD
Mailing Address - Street 2:SUITE 14-15
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-3415
Mailing Address - Country:US
Mailing Address - Phone:847-459-9119
Mailing Address - Fax:847-459-8115
Practice Address - Street 1:400 W DUNDEE RD
Practice Address - Street 2:SUITE 14-15
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-3415
Practice Address - Country:US
Practice Address - Phone:847-459-9119
Practice Address - Fax:847-459-8115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL060004934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1605476OtherBLUE CROSS BLUE SHIELD IL
IL5303296OtherAETNA
IL0403800001Medicare NSC
ILT39245Medicare UPIN
IL5303296OtherAETNA
IL0410048631Medicare PIN