Provider Demographics
NPI:1184140014
Name:EFP OPTICIANS ON DEARBORN, LLC
Entity type:Organization
Organization Name:EFP OPTICIANS ON DEARBORN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:BOYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOFFITT
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN, ABOC
Authorized Official - Phone:312-943-2020
Mailing Address - Street 1:1205 N DEARBORN ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-2213
Mailing Address - Country:US
Mailing Address - Phone:312-943-2020
Mailing Address - Fax:312-275-7189
Practice Address - Street 1:1205 N DEARBORN ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-2213
Practice Address - Country:US
Practice Address - Phone:312-943-2020
Practice Address - Fax:312-275-7189
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EFP PARTNERS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-08-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty