Provider Demographics
NPI:1689732232
Name:VISION BOUTIQUE, INC.
Entity Type:Organization
Organization Name:VISION BOUTIQUE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:BAYGOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-829-6800
Mailing Address - Street 1:948 W MADISON ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-2741
Mailing Address - Country:US
Mailing Address - Phone:312-829-6800
Mailing Address - Fax:312-829-3945
Practice Address - Street 1:948 W MADISON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-2741
Practice Address - Country:US
Practice Address - Phone:312-829-6800
Practice Address - Fax:312-829-3945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty