Organization Name: | CORLEY OPTICAL OF HINSDALE, INC |
NPI Number: | 1043397268 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | SUZANNE M MISIEWICZ (OWNER) |
Mailing Address: | 44 Village Pl Hinsdale |
State: | IL US |
Postal Code: | 605214132 |
Phone Number: | 6303231615 |
Fax Number: | 6303231615 |
NPI Enumeration Date: | 11/01/2006 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 156FX1800X |
License Number: | 2389-5853 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Eye and Vision Services Providers |
Taxonomy Classification: | Technician/Technologist |
Taxonomy Specialization: | Optician |
Taxonomy Definition: |