Organization
LUMEN OPTICAL ILLINOIS 4, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRENDON DEAN QUARNBERG (PRIVACY OFFICER)
(801) 316-5508
Entity
Organization
Contact information
Practice address
2420 N ELSTON, BUCKTOWN, IL 60647
(801) 316-5508
Mailing address
2420 N ELSTON, BUCKTOWN, IL 60647
(801) 316-5508
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
152WP0200X
Pediatric Optometrist
—
—
152WV0400X
Vision Therapy Optometrist
—
—
152WX0102X
Occupational Vision Optometrist
—
—
156F00000X
Technician/Technologist
—
—
156FC0800X
Contact Lens Technician/Technologist
—
—
156FC0801X
Contact Lens Fitter
—
—
156FX1800X
Optician
—
—
332H00000X
Eyewear Supplier
—
—
Other
Enumeration date
01/11/2017
Last updated
01/11/2017
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