Provider Demographics
NPI:1023229440
Name:ELITE OPTICAL LOOK DBA PEARLE VISON
Entity type:Organization
Organization Name:ELITE OPTICAL LOOK DBA PEARLE VISON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GINA
Authorized Official - Middle Name:
Authorized Official - Last Name:LIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-644-0885
Mailing Address - Street 1:410 N MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-4213
Mailing Address - Country:US
Mailing Address - Phone:312-644-0885
Mailing Address - Fax:312-222-1127
Practice Address - Street 1:410 N MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-4213
Practice Address - Country:US
Practice Address - Phone:312-644-0885
Practice Address - Fax:312-222-1127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1817003332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier