Organization
ICONIC OPTICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN YOUNG (OWNER)
(773) 857-3328
Entity
Organization
Contact information
Practice address
2915 N BROADWAY ST, CHICAGO, IL 60657-5313
(773) 857-3328
Mailing address
2915 N BROADWAY ST, CHICAGO, IL 60657-5313
(773) 857-3328
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Enumeration date
09/09/2015
Last updated
09/09/2015
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