Provider Demographics
NPI:1417007378
Name:ONE OR TWO, LTD.
Entity Type:Organization
Organization Name:ONE OR TWO, LTD.
Other - Org Name:PEARLE VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:D
Authorized Official - Last Name:BURGGRAF
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:815-756-3700
Mailing Address - Street 1:3272 SYCAMORE RD
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-9621
Mailing Address - Country:US
Mailing Address - Phone:815-756-3700
Mailing Address - Fax:815-756-3701
Practice Address - Street 1:3272 SYCAMORE RD
Practice Address - Street 2:
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-9621
Practice Address - Country:US
Practice Address - Phone:815-756-3700
Practice Address - Fax:815-756-3701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL00466713261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046006713Medicaid
IL046006713Medicaid
ILU81875Medicare UPIN
IL205201Medicare ID - Type UnspecifiedMEDICARE NUMBER