Provider Demographics
NPI:1457504771
Name:MY OPTICAL INC
Entity Type:Organization
Organization Name:MY OPTICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:YOUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-965-3715
Mailing Address - Street 1:806 CIVIC CENTER DR
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-3207
Mailing Address - Country:US
Mailing Address - Phone:847-965-3715
Mailing Address - Fax:847-965-3720
Practice Address - Street 1:806 CIVIC CENTER DR
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-3207
Practice Address - Country:US
Practice Address - Phone:847-965-3715
Practice Address - Fax:847-965-3720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-30
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty