Provider Demographics
NPI:1134204175
Name:KENILWORTH OPTICAL CO INC
Entity type:Organization
Organization Name:KENILWORTH OPTICAL CO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KRISHAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:NAGPAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-832-3055
Mailing Address - Street 1:135 S ROBERT T PALMER DR
Mailing Address - Street 2:SUITE 25
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-3412
Mailing Address - Country:US
Mailing Address - Phone:630-832-3055
Mailing Address - Fax:630-832-0927
Practice Address - Street 1:135 S ROBERT T PALMER DR
Practice Address - Street 2:SUITE 25
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-3412
Practice Address - Country:US
Practice Address - Phone:630-832-3055
Practice Address - Fax:630-832-0927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1149-7051207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL066393001OtherKRISHAN C NAGPAL, MD
IL066393001OtherKRISHAN C NAGPAL, MD
ILD12893Medicare UPIN
IL653630Medicare ID - Type UnspecifiedSUCHARITA ARORA, MD
IL483280Medicare ID - Type UnspecifiedKRISHAN C NAGPAL, MD
ILD14395Medicare UPIN