Provider Demographics
NPI:1669732566
Name:PALOS VISION CORRECTIONS PC
Entity type:Organization
Organization Name:PALOS VISION CORRECTIONS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:MONTWILL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:630-640-2464
Mailing Address - Street 1:11749 SOUTHWEST HWY
Mailing Address - Street 2:C
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1053
Mailing Address - Country:US
Mailing Address - Phone:630-640-2464
Mailing Address - Fax:708-361-5489
Practice Address - Street 1:11749 SOUTHWEST HWY
Practice Address - Street 2:C
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1053
Practice Address - Country:US
Practice Address - Phone:630-640-2464
Practice Address - Fax:708-361-5489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-24
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046008324152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty