Provider Demographics
NPI:1316168727
Name:EDENS OPTICIANS, INC.
Entity type:Organization
Organization Name:EDENS OPTICIANS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:EDENS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:708-499-3656
Mailing Address - Street 1:5569 W 95TH ST
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2356
Mailing Address - Country:US
Mailing Address - Phone:708-499-3656
Mailing Address - Fax:773-238-5277
Practice Address - Street 1:5569 W 95TH ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2356
Practice Address - Country:US
Practice Address - Phone:708-499-3656
Practice Address - Fax:773-238-5277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0704710001Medicare UPIN
IL0704710001Medicare NSC