Provider Demographics
NPI:1659704682
Name:PARK RIDGE NORTH SUBURBAN VISION CONSULTANTS LLC
Entity Type:Organization
Organization Name:PARK RIDGE NORTH SUBURBAN VISION CONSULTANTS LLC
Other - Org Name:NORTH SUBURBAN VISION CONSULTANTS-PARK RIDGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PRESS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:847-823-8283
Mailing Address - Street 1:303 N NORTHWEST HWY
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-3366
Mailing Address - Country:US
Mailing Address - Phone:847-823-8283
Mailing Address - Fax:847-823-1099
Practice Address - Street 1:303 N NORTHWEST HWY
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-3366
Practice Address - Country:US
Practice Address - Phone:847-823-8283
Practice Address - Fax:847-823-1099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-13
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046010530152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL12412411OtherCAQH