Provider Demographics
NPI:1861823361
Name:GALILEO OPTICAL CO.
Entity Type:Organization
Organization Name:GALILEO OPTICAL CO.
Other - Org Name:DA VINCI VISION BOUTIQUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SALVATORE
Authorized Official - Middle Name:
Authorized Official - Last Name:ARENELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-549-2020
Mailing Address - Street 1:1449 W FULLERTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-8027
Mailing Address - Country:US
Mailing Address - Phone:773-549-2020
Mailing Address - Fax:
Practice Address - Street 1:1449 W FULLERTON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-8027
Practice Address - Country:US
Practice Address - Phone:773-549-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GALILEO OPTICAL CO.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-12-09
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No332H00000XSuppliersEyewear SupplierGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL363768679002Medicaid