Basic Information
| Provider Information | |||||||||
| NPI: | 1659602936 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | A&R OPTICAL, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 307 HICKORY LN | ||||||||
| Address2: | |||||||||
| City: | SCHAUMBURG | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601931516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8478913992 | ||||||||
| FaxNumber: | 8478913992 | ||||||||
| Practice Location | |||||||||
| Address1: | 307 HICKORY LN | ||||||||
| Address2: | |||||||||
| City: | SCHAUMBURG | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601931516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8478913992 | ||||||||
| FaxNumber: | 8478913992 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2010 | ||||||||
| LastUpdateDate: | 01/26/2010 | ||||||||
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| AuthorizedOfficialLastName: | PALATNICK | ||||||||
| AuthorizedOfficialFirstName: | ALLAN | ||||||||
| AuthorizedOfficialMiddleName: | H | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8478913992 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | OD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 046008758 | IL | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist | 152W00000X | 046006675 | IL | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 046006675 | 05 | IL | MEDICAID |