Provider Demographics
NPI:1023414539
Name:KISH OPTICAL INC.
Entity type:Organization
Organization Name:KISH OPTICAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KISHWER
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAKEEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-623-2060
Mailing Address - Street 1:969 BRISTOL ST
Mailing Address - Street 2:
Mailing Address - City:PINGREE GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60140-9185
Mailing Address - Country:US
Mailing Address - Phone:224-623-2060
Mailing Address - Fax:
Practice Address - Street 1:969 BRISTOL ST
Practice Address - Street 2:
Practice Address - City:PINGREE GROVE
Practice Address - State:IL
Practice Address - Zip Code:60140-9185
Practice Address - Country:US
Practice Address - Phone:224-623-2060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-10
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier