Forouzandeh Alavi, O.D.
Individual provider Active NPI Optometrist · Niles, IL
NPI 1740437706 · NPPES record last updated Aug 21, 2008
Key facts
- NPI
- 1740437706
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 046010140 (IL)
- Practice address
- 7107 W Dempster St
Niles, IL 60714-2131 - Phone
- (847) 965-2695
- Fax
- (847) 965-0250
- NPI assigned
- Aug 21, 2008
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 046010140 | IL | MD | Optometrist |
| 047934493 | IL | MD | Optometrist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 046010140 | IL | Yes |
| Optometrist | 152W00000X | 047934493 | IL |
Addresses
Primary practice location
7107 W Dempster St
Niles, IL 60714-2131
Mailing address
7107 W Dempster St
Niles, IL 60714-2131
Phone (847) 965-2695
Other providers in Niles, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 21, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.