Provider Demographics
NPI:1750657110
Name:AFFORDABLE OPTICAL OF WHEELING,INC
Entity Type:Organization
Organization Name:AFFORDABLE OPTICAL OF WHEELING,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
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 1:92 S. MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090
Mailing Address - Country:US
Mailing Address - Phone:847-419-9009
Mailing Address - Fax:847-419-9008
Practice Address - Street 1:92 S. MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:IL
Practice Address - Zip Code:60090
Practice Address - Country:US
Practice Address - Phone:847-419-9009
Practice Address - Fax:847-419-9008
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AFFORDABLE OPTICAL,INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-03-29
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty