Provider Demographics
NPI:1518098318
Name:PRIZIVA OPTICAL, LTD.
Entity Type:Organization
Organization Name:PRIZIVA OPTICAL, LTD.
Other - Org Name:PEARLE VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RORY
Authorized Official - Middle Name:K
Authorized Official - Last Name:ZIMNY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-921-0900
Mailing Address - Street 1:1701 N LARKIN AVE
Mailing Address - Street 2:105
Mailing Address - City:CREST HILL
Mailing Address - State:IL
Mailing Address - Zip Code:60403-1970
Mailing Address - Country:US
Mailing Address - Phone:815-741-1140
Mailing Address - Fax:815-741-8449
Practice Address - Street 1:1701 N LARKIN AVE
Practice Address - Street 2:105
Practice Address - City:CREST HILL
Practice Address - State:IL
Practice Address - Zip Code:60403-1970
Practice Address - Country:US
Practice Address - Phone:815-741-1140
Practice Address - Fax:815-741-8449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL6337580001Medicare NSC