Organization
LUMEN OPTICAL ILLINOIS 1, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HEATHER ALLEN (PRIVACY OFFICER)
(801) 316-5508
Entity
Organization
Contact information
Practice address
20505 RAND RD, KILDEER, IL 60047-3004
(801) 792-0477
Mailing address
20505 RAND RD, SUITE 500, KILDEER, IL 60047-3004
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
152WC0802X
Corneal and Contact Management Optometrist
—
—
152WL0500X
Low Vision Rehabilitation Optometrist
—
—
152WP0200X
Pediatric Optometrist
—
—
152WS0006X
Sports Vision Optometrist
—
—
152WV0400X
Vision Therapy Optometrist
—
—
156F00000X
Technician/Technologist
—
—
156FC0800X
Contact Lens Technician/Technologist
—
—
156FC0801X
Contact Lens Fitter
—
—
156FX1800X
Optician
—
—
332H00000X
Eyewear Supplier
—
—
Other
Enumeration date
12/18/2015
Last updated
01/21/2016
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