Provider Demographics
NPI:1407227341
Name:NORWOOD PARK EYE CENTER, LLC
Entity Type:Organization
Organization Name:NORWOOD PARK EYE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:DOMINICK
Authorized Official - Middle Name:
Authorized Official - Last Name:OPITZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:708-217-1791
Mailing Address - Street 1:6107 N NORTHWEST HWY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-2127
Mailing Address - Country:US
Mailing Address - Phone:773-315-8372
Mailing Address - Fax:
Practice Address - Street 1:6107 N NORTHWEST HWY
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-2127
Practice Address - Country:US
Practice Address - Phone:773-315-8372
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-19
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILO46008976152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty