Provider Demographics
NPI:1952310591
Name:MCHENRY OPTICAL LTD.
Entity Type:Organization
Organization Name:MCHENRY OPTICAL LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SADOFSKY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:815-385-9240
Mailing Address - Street 1:4005 W. KANE AVE.
Mailing Address - Street 2:SUITE F
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-6305
Mailing Address - Country:US
Mailing Address - Phone:815-385-9240
Mailing Address - Fax:815-385-7512
Practice Address - Street 1:4005 W KANE AVE
Practice Address - Street 2:SUITE F
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-6305
Practice Address - Country:US
Practice Address - Phone:815-385-9240
Practice Address - Fax:815-385-7512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046007622152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL320420Medicare ID - Type Unspecified
IL0005615137Medicare UPIN
IL0203000002Medicare NSC