Provider Demographics
NPI:1437341112
Name:ASSOCIATES IN OPTOMETRY
Entity Type:Organization
Organization Name:ASSOCIATES IN OPTOMETRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:PAWLYK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-736-2800
Mailing Address - Street 1:4744 W PETERSON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-5706
Mailing Address - Country:US
Mailing Address - Phone:773-736-2800
Mailing Address - Fax:773-736-2802
Practice Address - Street 1:4744 W PETERSON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-5706
Practice Address - Country:US
Practice Address - Phone:773-736-2800
Practice Address - Fax:773-736-2802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-15
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL951820Medicare PIN