Provider Demographics
NPI:1023138955
Name:PEALE VISION
Entity type:Organization
Organization Name:PEALE VISION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TATYANA
Authorized Official - Middle Name:
Authorized Official - Last Name:LALAYLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-482-9990
Mailing Address - Street 1:233 WAUKEGAN RD
Mailing Address - Street 2:
Mailing Address - City:LAKE BLUFF
Mailing Address - State:IL
Mailing Address - Zip Code:60044-1666
Mailing Address - Country:US
Mailing Address - Phone:847-482-9990
Mailing Address - Fax:
Practice Address - Street 1:233 WAUKEGAN RD
Practice Address - Street 2:
Practice Address - City:LAKE BLUFF
Practice Address - State:IL
Practice Address - Zip Code:60044-1666
Practice Address - Country:US
Practice Address - Phone:847-482-9990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty