Provider Demographics
NPI:1386884575
Name:KORNEAL KONTAX
Entity type:Organization
Organization Name:KORNEAL KONTAX
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:G
Authorized Official - Last Name:GREENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-238-7450
Mailing Address - Street 1:9928 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-1831
Mailing Address - Country:US
Mailing Address - Phone:773-238-7450
Mailing Address - Fax:773-238-6487
Practice Address - Street 1:9928 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-1831
Practice Address - Country:US
Practice Address - Phone:773-238-7450
Practice Address - Fax:773-238-6487
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PEARLE VISION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-02-27
Last Update Date:2009-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier