Provider Demographics
NPI:1568631703
Name:AFFORDABLE OPTICAL INC
Entity Type:Organization
Organization Name:AFFORDABLE OPTICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:INNA
Authorized Official - Middle Name:
Authorized Official - Last Name:AZRIKAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-855-9009
Mailing Address - Street 1:6170 WEST GRAND AVE
Mailing Address - Street 2:#451
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031
Mailing Address - Country:US
Mailing Address - Phone:847-855-9009
Mailing Address - Fax:847-855-9008
Practice Address - Street 1:6170 WEST GRAND AVE
Practice Address - Street 2:#451
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031
Practice Address - Country:US
Practice Address - Phone:847-855-9009
Practice Address - Fax:847-855-9008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL6BL-2008-124152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1L8861OtherEYE MED
ILAFFORDABLE06OtherDAVIS
ILAO10091OtherSPECTERA
ILAFFORDABLE06OtherDAVIS