Organization
VIDULICH, BLASE & VALENTINO, P.C.
Active
Other names
PEARLE EXPRESS
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SPENCER P VIDULICH O.D. (OWNER)
(773) 327-3000
Entity
Organization
Contact information
Practice address
1730 W FULLERTON AVE, CHICAGO, IL 60614-1900
(773) 327-3000
(773) 327-3012
Mailing address
1730 W FULLERTON AVE, CHICAGO, IL 60614-1900
(773) 327-3000
(773) 327-3012
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
958640
MEDICARE GROUP
IL
Enumeration date
08/22/2007
Last updated
10/04/2007
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