Provider Demographics
NPI:1194719112
Name:NEW VISION OPTICAL
Entity type:Organization
Organization Name:NEW VISION OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:ANTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-251-3330
Mailing Address - Street 1:24081 FLINT CREEK DR
Mailing Address - Street 2:
Mailing Address - City:LAKE BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-1581
Mailing Address - Country:US
Mailing Address - Phone:847-251-3330
Mailing Address - Fax:847-251-9580
Practice Address - Street 1:120 SKOKIE BLVD
Practice Address - Street 2:
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-3050
Practice Address - Country:US
Practice Address - Phone:847-251-3330
Practice Address - Fax:847-251-9580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-06
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1935332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0743140001Medicare ID - Type Unspecified