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NPI Code Detail

MEDICARE: DR. RUSSUL ABBAS OD

MEDICARE: DR. RUSSUL ABBAS OD
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
1152W00000XOptometrist046.011371IL

General Provider Information

NPI Number : 1285129007
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RUSSUL ABBAS OD
Provider Business Mailing Address
First Line : 3450 N LAKE SHORE DR APT 3101
Second Line :
City : CHICAGO
State : IL
Zip : 60657-2863
Country : US
Telephone Number : 352-870-3824
Fax Number :
Provider Business Practice Location Address
First Line : 48 S GREENLEAF ST
Second Line :
City : GURNEE
State : IL
Zip : 60031-3300
Country : US
Telephone Number : 847-662-4016
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/25/2018
Last Update Date : 09/05/2019

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