Organization
THE EYEGLASS SHOP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DOROTHY M SPOURDALAKIS CERTIFIED OPTICAN (MANAGER)
(708) 848-6640
Entity
Organization
Contact information
Practice address
715 LAKE ST, OAK PARK, IL 60301-1422
(708) 848-6640
(708) 848-6646
Mailing address
715 LAKE STREET - LOBBY, OAK PARK, IL 60301
(708) 848-6640
(708) 848-6646
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001633598
BLUE CROSS BLUE SHIELD
IL
01
—
OP1101
EYEMED
IL
Enumeration date
01/19/2007
Last updated
08/22/2020
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