Imad Dababneh

Primary specialty

OptometristTaxonomy code 152W00000X

License

046.011072 Issued in IL

Practice address

4150 Williamsburg CT. Apt 101
Glenview, IL 60025

Phone

(708) 770-6005

NPI assigned

Nov 17, 2016

Last updated

Nov 17, 2016By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1479340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1479340800000",
    "number": "1073055398",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4150 WILLIAMSBURG CT APT 101",
            "city": "GLENVIEW",
            "state": "IL",
            "postal_code": "600253886",
            "telephone_number": "708-770-6005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4150 WILLIAMSBURG CT. APT 101",
            "city": "GLENVIEW",
            "state": "IL",
            "postal_code": "60025",
            "telephone_number": "708-770-6005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DABABNEH",
        "first_name": "IMAD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-11-17",
        "last_updated": "2016-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046.011072",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OR",
            "license": "2185D",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in Glenview, IL
• Providers in Glenview, IL by specialty
• Optometrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.