Provider Demographics
NPI:1619475852
Name:ALBINA OPTOMETRIC
Entity Type:Organization
Organization Name:ALBINA OPTOMETRIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NAJIB
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:ALBINA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:312-802-4137
Mailing Address - Street 1:535 N MICHIGAN AVENUE
Mailing Address - Street 2:APARTMENT 1404
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611
Mailing Address - Country:US
Mailing Address - Phone:312-802-4137
Mailing Address - Fax:
Practice Address - Street 1:THE EYE CARE CENTER, LTD
Practice Address - Street 2:8525 S HARLEM AVE
Practice Address - City:BURBANK
Practice Address - State:IL
Practice Address - Zip Code:60459
Practice Address - Country:US
Practice Address - Phone:708-599-0050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-23
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046009577152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046009577Medicaid