Provider Demographics
NPI:1265572465
Name:M&M OPTICAL INC
Entity type:Organization
Organization Name:M&M OPTICAL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:B
Authorized Official - Last Name:BUSCH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:708-482-7744
Mailing Address - Street 1:1741 PINEHURST LN
Mailing Address - Street 2:
Mailing Address - City:FLOSSMOOR
Mailing Address - State:IL
Mailing Address - Zip Code:60422-1964
Mailing Address - Country:US
Mailing Address - Phone:708-799-0920
Mailing Address - Fax:708-798-1349
Practice Address - Street 1:18234 HALSTED ST
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-2508
Practice Address - Country:US
Practice Address - Phone:708-798-7711
Practice Address - Fax:708-798-1349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046.006948152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty