Organization
FOR EYES OPTICAL COMPANY OF PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSE COSTA (CEO)
(954) 305-9004
Entity
Organization
Contact information
Practice address
9900 S RIDGLELAND AVE, CHICAGO RIDGE, IL 60643
(708) 422-9390
Mailing address
3601 SW 160TH AVE STE 400, MIRAMAR, FL 33027-6312
(305) 557-9004
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Enumeration date
01/18/2019
Last updated
01/18/2019
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