Provider Demographics
NPI:1447400676
Name:AMERICAN CRYSTAL OPTICAL
Entity Type:Organization
Organization Name:AMERICAN CRYSTAL OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZUNIGA
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:773-252-5025
Mailing Address - Street 1:3752 W FULLERTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-2331
Mailing Address - Country:US
Mailing Address - Phone:773-252-5025
Mailing Address - Fax:773-252-6425
Practice Address - Street 1:3752 W FULLERTON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-2331
Practice Address - Country:US
Practice Address - Phone:773-252-5025
Practice Address - Fax:773-252-6425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-24
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL261Q00000X261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center