MEDICARE: DR. VIKTORIYA MARMUR O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist		IL

General Provider Information

NPI Number	:	1114023785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VIKTORIYA MARMUR O.D.

Provider Business Mailing Address
First Line	:	70 W BURTON PL APT 1206
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60610-1468
Country	:	US
Telephone Number	:	224-595-0595
Fax Number	:

Provider Business Practice Location Address
First Line	:	2734 N MILWAUKEE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-1362
Country	:	US
Telephone Number	:	773-862-5000
Fax Number	:	773-862-5059

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	07/08/2007

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