Provider Demographics
NPI:1215688619
Name:THE EYEGLASS STORE INC
Entity type:Organization
Organization Name:THE EYEGLASS STORE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MINAS
Authorized Official - Middle Name:
Authorized Official - Last Name:SPOURDALAKIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-848-6640
Mailing Address - Street 1:715 LAKE STREET
Mailing Address - Street 2:STE 130
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301-1422
Mailing Address - Country:US
Mailing Address - Phone:708-848-6640
Mailing Address - Fax:708-848-6646
Practice Address - Street 1:715 LAKE ST STE 130
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1403
Practice Address - Country:US
Practice Address - Phone:708-848-6640
Practice Address - Fax:708-848-6646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-17
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
No261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery