Provider Demographics
NPI:1356588511
Name:OPTICAL EXPRESSIONS, INC.
Entity type:Organization
Organization Name:OPTICAL EXPRESSIONS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MITAL
Authorized Official - Suffix:
Authorized Official - Credentials:ABOC
Authorized Official - Phone:630-752-0595
Mailing Address - Street 1:160 DANADA SQ W
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60189-2041
Mailing Address - Country:US
Mailing Address - Phone:630-752-0595
Mailing Address - Fax:630-752-0145
Practice Address - Street 1:160 DANADA SQ W
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60189-2041
Practice Address - Country:US
Practice Address - Phone:630-752-0595
Practice Address - Fax:630-752-0145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-09
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046007064152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty