Provider Demographics
NPI:1255947305
Name:RES OPTICAL LLC
Entity type:Organization
Organization Name:RES OPTICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:NGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-775-0811
Mailing Address - Street 1:7447 W TALCOTT AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-3714
Mailing Address - Country:US
Mailing Address - Phone:773-775-0811
Mailing Address - Fax:773-819-7013
Practice Address - Street 1:7447 W TALCOTT AVE STE 300
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-3714
Practice Address - Country:US
Practice Address - Phone:773-775-0811
Practice Address - Fax:773-819-7013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-23
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1033421227OtherNPI
1043335094OtherNPI