Provider Demographics
NPI:1649433442
Name:INTERNATIONAL MISSIONS ALLIANCE
Entity type:Organization
Organization Name:INTERNATIONAL MISSIONS ALLIANCE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PETRU
Authorized Official - Middle Name:
Authorized Official - Last Name:AMAREI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-252-5115
Mailing Address - Street 1:2880 N MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-7413
Mailing Address - Country:US
Mailing Address - Phone:773-252-5115
Mailing Address - Fax:
Practice Address - Street 1:2880 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-7413
Practice Address - Country:US
Practice Address - Phone:773-252-5115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL152W00000XOtherOPTICAL DISPENSING (TAXONOMY)