Provider Demographics
NPI:1821435660
Name:730 NORTH OPTOMETRY PC
Entity Type:Organization
Organization Name:730 NORTH OPTOMETRY PC
Other - Org Name:730 NORTH OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:C
Authorized Official - Last Name:PAK OH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:312-282-5661
Mailing Address - Street 1:730 N MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-1914
Mailing Address - Country:US
Mailing Address - Phone:847-362-9900
Mailing Address - Fax:847-362-9936
Practice Address - Street 1:730 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-1914
Practice Address - Country:US
Practice Address - Phone:847-362-9900
Practice Address - Fax:847-362-9936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-03
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty