Provider Demographics
NPI:1548602428
Name:CLEARING VISION PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:CLEARING VISION PROFESSIONAL CORPORATION
Other - Org Name:CLEARING VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:MICAECA
Authorized Official - Middle Name:
Authorized Official - Last Name:TOLEDO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:773-489-2985
Mailing Address - Street 1:5718 W. 63RD ST.
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60638
Mailing Address - Country:US
Mailing Address - Phone:773-498-2985
Mailing Address - Fax:773-498-6042
Practice Address - Street 1:5718 W. 63RD ST.
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60638
Practice Address - Country:US
Practice Address - Phone:773-498-2985
Practice Address - Fax:773-498-6042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-22
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046010295152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty