Provider Demographics
NPI:1922159060
Name:MINK RESOURCES, LTD.
Entity Type:Organization
Organization Name:MINK RESOURCES, LTD.
Other - Org Name:PEARLE VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:D
Authorized Official - Last Name:BURGGRAF
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:815-756-3700
Mailing Address - Street 1:620 W VETERANS PKWY
Mailing Address - Street 2:
Mailing Address - City:YORKVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60560-4567
Mailing Address - Country:US
Mailing Address - Phone:630-882-8401
Mailing Address - Fax:630-882-8407
Practice Address - Street 1:620 W VETERANS PKWY
Practice Address - Street 2:
Practice Address - City:YORKVILLE
Practice Address - State:IL
Practice Address - Zip Code:60560-4567
Practice Address - Country:US
Practice Address - Phone:630-882-8401
Practice Address - Fax:630-882-8407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL00466713152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL215176OtherMEDICARE NUMBER
IL215176OtherMEDICARE NUMBER
IL=========OtherEIN