Organization
ERNEST I. WATANABE, O.D. LTD.
Active
Other names
Granville Vision Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ERNEST ISAMU WATANABE O.D. (PRESIDENT)
(773) 465-6660
Entity
Organization
Contact information
Practice address
1108 W GRANVILLE AVE, CHICAGO, IL 60660-2013
(773) 465-6660
(773) 274-8222
Mailing address
1108 W GRANVILLE AVE, CHICAGO, IL 60660-2013
(773) 465-6660
(773) 274-8222
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
046006692
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
046006692
IL STATE LICENSE
IL
01
—
1053488569
INDIVIDUAL NPI #
—
Enumeration date
12/27/2007
Last updated
09/09/2008
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