Provider Demographics
NPI:1760012645
Name:PRICE OPTICAL VISION SPECIALISTS LLC
Entity Type:Organization
Organization Name:PRICE OPTICAL VISION SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CALVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:VANCE
Authorized Official - Suffix:III
Authorized Official - Credentials:OD
Authorized Official - Phone:773-474-6673
Mailing Address - Street 1:8541 S COTTAGE GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619-6115
Mailing Address - Country:US
Mailing Address - Phone:773-651-7106
Mailing Address - Fax:
Practice Address - Street 1:8541 S COTTAGE GROVE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-6115
Practice Address - Country:US
Practice Address - Phone:773-651-7106
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-20
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty