Provider Demographics
NPI:1548446610
Name:R. W. OPTOMETRIC CENTER, INC.
Entity type:Organization
Organization Name:R. W. OPTOMETRIC CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:WOLF
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:815-338-7810
Mailing Address - Street 1:206 N MADISON ST
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:IL
Mailing Address - Zip Code:60098-3450
Mailing Address - Country:US
Mailing Address - Phone:815-338-7810
Mailing Address - Fax:815-338-7520
Practice Address - Street 1:206 N MADISON ST
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:IL
Practice Address - Zip Code:60098-3450
Practice Address - Country:US
Practice Address - Phone:815-338-7810
Practice Address - Fax:815-338-7520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-18
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1259240001Medicare NSC
IL398760Medicare PIN