MEDICARE: DR. MARVIN AAL 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	1260	AZ
2	152W00000X	Optometrist		IL

General Provider Information

NPI Number	:	1184634180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARVIN AAL O.D.

Provider Business Mailing Address
First Line	:	1155 N DEARBORN ST
Second Line	:	803
City	:	CHICAGO
State	:	IL
Zip	:	60610-3421
Country	:	US
Telephone Number	:	312-751-0029
Fax Number	:

Provider Business Practice Location Address
First Line	:	1155 N DEARBORN ST
Second Line	:	803
City	:	CHICAGO
State	:	IL
Zip	:	60610-3421
Country	:	US
Telephone Number	:	312-751-0029
Fax Number	:

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

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

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