Provider Demographics
NPI:1760785372
Name:BOSS OPTICAL INC
Entity Type:Organization
Organization Name:BOSS OPTICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PO
Authorized Official - Middle Name:SEUNG
Authorized Official - Last Name:LAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-388-1388
Mailing Address - Street 1:215 W 23RD ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-1903
Mailing Address - Country:US
Mailing Address - Phone:312-225-3188
Mailing Address - Fax:312-225-9188
Practice Address - Street 1:215 W 23RD ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-1903
Practice Address - Country:US
Practice Address - Phone:312-225-3188
Practice Address - Fax:312-225-9188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-21
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL40093379332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier