# ERNEST I. WATANABE, O.D. LTD.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Granville Vision Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1285818120
- **Authorized official:** DR. ERNEST ISAMU WATANABE O.D. (PRESIDENT)
- **Authorized official phone:** (773) 465-6660

## Contact information

- **Practice address:** 1108 W GRANVILLE AVE, CHICAGO, IL 60660-2013
- **Practice address phone:** (773) 465-6660
- **Practice address fax:** (773) 274-8222
- **Mailing address:** 1108 W GRANVILLE AVE, CHICAGO, IL 60660-2013
- **Mailing address phone:** (773) 465-6660
- **Mailing address fax:** (773) 274-8222

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | 046006692 | IL | Yes |

## Other

- **Enumeration date:** 12/27/2007
- **Last updated:** 09/09/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 046006692 | IL STATE LICENSE | IL |
| 01 | — | 1053488569 | INDIVIDUAL NPI \# | — |