Lumen Optical Illinois 4, LLC
Organization Active NPI Optometrist · Bucktown, IL
NPI 1700322922 · NPPES record last updated Jan 11, 2017
Key facts
- NPI
- 1700322922
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- Legal business name
- LUMEN OPTICAL ILLINOIS 4, LLC
- Practice address
- 2420 N Elston
Bucktown, IL 60647 - Phone
- (801) 316-5508
- NPI assigned
- Jan 11, 2017
- Organization subpart
- No
Authorized official
- Name
- Brendon Dean Quarnberg
- Title
- Privacy Officer
- Phone
- (801) 316-5508
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | Yes | ||
| Pediatric Optometrist |
152WP0200X | |||
| Vision Therapy Optometrist |
152WV0400X | |||
| Occupational Vision Optometrist |
152WX0102X | |||
| Technician/Technologist |
156F00000X | |||
| Contact Lens Technician/Technologist |
156FC0800X | |||
| Contact Lens Fitter |
156FC0801X | |||
| Optician |
156FX1800X | |||
| Eyewear Supplier | 332H00000X |
Addresses
Primary practice location
2420 N Elston
Bucktown, IL 60647
Mailing address
2420 N Elston
Bucktown, IL 60647
Phone (801) 316-5508
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 11, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.