Provider Demographics
NPI:1821168428
Name:CHITTICK OPTICAL INC
Entity Type:Organization
Organization Name:CHITTICK OPTICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WAGIH
Authorized Official - Middle Name:A
Authorized Official - Last Name:SATAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-385-2225
Mailing Address - Street 1:2020 SHERMAN DR
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:IN
Mailing Address - Zip Code:47670-1045
Mailing Address - Country:US
Mailing Address - Phone:812-385-2225
Mailing Address - Fax:812-385-2314
Practice Address - Street 1:1213 STATE STREET
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62439-2332
Practice Address - Country:US
Practice Address - Phone:618-943-5713
Practice Address - Fax:618-943-5716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046.010205152W00000X
IL036.064073207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0176390001Medicare NSC
IL232970Medicare PIN