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Active NPI 1104021179 Organization (Entity Type 2)

Eagle Optical, Inc.

Eyewear Supplier • Lansing, IL

About Eagle Optical, Inc. NPI 1104021179 Summary

Eagle Optical, Inc. is a verified healthcare organization specializing in Eyewear Supplier operating in Lansing, IL. Located at 2755 INDIANA AVE, this facility provides patient care and medical services under National Provider Identifier (NPI) 1104021179.

Administrative operations and authorized compliance are overseen by James Novak (President).

Facility Location & Contact Primary Location

Facility Address

2755 Indiana Ave

Lansing, IL 604382225

Telephone 7084743500
Fax 7084743556

Authorized Official Information

Authorized Contact Name

MR. James Novak

Title / Role

President

Official Telephone

7084743500

Facility Classifications & Specialties

Eyewear Supplier Primary Taxonomy

NUCC Taxonomy Code: 332H00000X

An organization that provides spectacles, contact lenses, and other vision enhancement devices prescribed by an optometrist or ophthalmologist.

Facility & Registry History Timeline

Chronological log of verified NPI organization updates, branch relocations, and registry updates

6 Historical Events
NPI Profile Active July 08, 2007

NPI status registered as active in NPPES database

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Updated Practice Location July 08, 2007

Registered at 2755 INDIANA AVE, LANSING, IL 604382225 (Tel: 7084743500)

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Updated Business Mailing Address July 08, 2007

Registered at 2755 INDIANA AVE, LANSING, IL 604382225 (Tel: 7084743500)

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Organization / Clinic Name Updated July 08, 2007

Operating as EAGLE OPTICAL, INC.

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Medical Taxonomy / Specialty Registered (Primary Specialty) July 08, 2007

Eyewear Supplier

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Initial NPI Registration & Enumeration June 19, 2007

First registered as active Healthcare Organization in NPPES Database.

Patient & Community Reviews

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NPI Organization Metadata

NPI Number: 1104021179
Entity Type:
Organization Organization (Hospital, Clinic, Group Practice) (Type 2 NPI)
Enumeration Date: June 19, 2007
Last Update: August 22, 2020

Mailing Address

2755 Indiana Ave

Lansing, IL 604382225

Phone: 7084743500

Public Domain Record This organization profile is sourced from public domain datasets published by CMS and NPPES under FOIA.
⚠️ Medical Disclaimer

Facility details are provided for public information only. In case of a medical emergency, call 911 immediately.