Organization
VIDULICH, BLASE & VALENTINO, P.C.
Active
Other names
Pearle Express
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SPENCER P. VIDULICH O.D. (PRESIDENT)
(773) 327-3000
Entity
Organization
Contact information
Practice address
1730 W FULLERTON AVE, PEARLE EXPRESS, CHICAGO, IL 60614-1900
(773) 327-3000
(773) 327-3015
Mailing address
1730 W FULLERTON AVE, PEARLE EXPRESS, CHICAGO, IL 60614-1900
(773) 327-3000
(773) 327-3015
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
958640
MEDICARE GROUP NUMBER
IL
Enumeration date
11/09/2005
Last updated
11/08/2007
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