Provider Demographics
NPI:1649428640
Name:AV EYE BOUTIQUE INC
Entity type:Organization
Organization Name:AV EYE BOUTIQUE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SVETLANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUCHNIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-537-2020
Mailing Address - Street 1:43 HUNTINGTON LANE
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090
Mailing Address - Country:US
Mailing Address - Phone:847-537-2020
Mailing Address - Fax:847-537-3887
Practice Address - Street 1:43 HUNTINGTON LN
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:IL
Practice Address - Zip Code:60090-6908
Practice Address - Country:US
Practice Address - Phone:847-537-2020
Practice Address - Fax:847-537-3887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service