Provider Demographics
NPI:1831120005
Name:THADDEUS, LTD
Entity Type:Organization
Organization Name:THADDEUS, LTD
Other - Org Name:PEARLE VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SPENCER
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:VIDULICH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:773-327-3000
Mailing Address - Street 1:4017 N MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-1834
Mailing Address - Country:US
Mailing Address - Phone:773-545-2660
Mailing Address - Fax:
Practice Address - Street 1:4017 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-1834
Practice Address - Country:US
Practice Address - Phone:773-545-2660
Practice Address - Fax:773-327-3015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL060-0005772152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL323940Medicare UPIN