MEDICARE: PRASOD C RAMACHANDRAN 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
1	152W00000X	Optometrist	046008787	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295893808
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRASOD C RAMACHANDRAN OD

Provider Business Mailing Address
First Line	:	3624 W 26TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60623
Country	:	US
Telephone Number	:	773-762-5662
Fax Number	:	773-762-0721

Provider Business Practice Location Address
First Line	:	3624 W 26TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60623
Country	:	US
Telephone Number	:	773-762-5662
Fax Number	:	773-762-0721

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

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	08/10/2012

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