Provider Demographics
NPI:1578694386
Name:ZIVA OPTICAL, LTD.
Entity Type:Organization
Organization Name:ZIVA 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 1:1243 W BOUGHTON RD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-1509
Mailing Address - Country:US
Mailing Address - Phone:630-679-0900
Mailing Address - Fax:630-679-0213
Practice Address - Street 1:1243 W BOUGHTON RD
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-1509
Practice Address - Country:US
Practice Address - Phone:630-679-0900
Practice Address - Fax:630-679-0213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1214140001Medicare NSC