Organization
PUPIL VISION CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RENEE RUSSO (ADMINISTRATOR)
(312) 350-8269
Entity
Organization
Contact information
Practice address
5233 N LINCOLN AVE, CHICAGO, IL 60625-2405
(312) 350-8269
Mailing address
5233 N LINCOLN AVE, CHICAGO, IL 60625-2405
(312) 350-8269
Taxonomy
Speciality
Code
Description
License number
State
156FX1202X
Optometric Technician
Primary
—
—
302R00000X
Health Maintenance Organization
—
—
Other
Enumeration date
09/05/2014
Last updated
09/05/2014
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