Organization
INDUSTRIAL OPTICAL SERVICE, INC.
Active
Other names
Coventry Eyecare
Organization subpart
No
Provider details
NPI number
Authorized official
DANIEL LIEBERMAN O.D. (OWNER)
(847) 864-0300
Entity
Organization
Contact information
Practice address
2000 CENTRAL ST, EVANSTON, IL 60201-2218
(847) 864-0300
Mailing address
4418 W DIVERSEY AVE, CHICAGO, IL 60639-1924
(773) 736-6800
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1636706
BCBS
IL
01
—
7235044
AETNA
IL
Enumeration date
01/11/2007
Last updated
05/15/2008
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