Provider Demographics
NPI:1487817409
Name:GUILE'S EYEWEAR BOUTIQUE INC.
Entity Type:Organization
Organization Name:GUILE'S EYEWEAR BOUTIQUE INC.
Other - Org Name:NONE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:GUILE
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:NONE
Authorized Official - Phone:773-545-9641
Mailing Address - Street 1:3041 N LOTUS AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-4818
Mailing Address - Country:US
Mailing Address - Phone:773-545-9641
Mailing Address - Fax:773-545-9541
Practice Address - Street 1:3041 N LOTUS AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-4818
Practice Address - Country:US
Practice Address - Phone:773-545-9641
Practice Address - Fax:773-545-9541
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NONE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-09
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL35978260156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty