Provider Demographics
NPI:1063610046
Name:THE OPTICAL CENTER INC
Entity type:Organization
Organization Name:THE OPTICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:G
Authorized Official - Last Name:SCHAEFGEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-455-5330
Mailing Address - Street 1:368 VIRGINIA ST
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014
Mailing Address - Country:US
Mailing Address - Phone:815-455-5330
Mailing Address - Fax:815-455-5761
Practice Address - Street 1:368 VIRGINIA ST
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014
Practice Address - Country:US
Practice Address - Phone:815-455-5330
Practice Address - Fax:815-455-5761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty