MEDICARE: ELYSE L CHAGLASIAN 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	046008200	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6046380001	OTHER	IL	NATIONAL GOVERNMENT SERVICES
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740273234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELYSE L CHAGLASIAN OD

Provider Business Mailing Address
First Line	:	1585 BARRINGTON RD
Second Line	:	SUITE 404
City	:	HOFFMAN ESTATES
State	:	IL
Zip	:	60169-1090
Country	:	US
Telephone Number	:	847-755-9393
Fax Number	:	847-755-1560

Provider Business Practice Location Address
First Line	:	1585 BARRINGTON RD
Second Line	:	SUITE 404
City	:	HOFFMAN ESTATES
State	:	IL
Zip	:	60169-1090
Country	:	US
Telephone Number	:	847-755-9393
Fax Number	:	847-755-1560

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

Provider Enumeration Date	:	08/30/2005
Last Update Date	:	06/19/2009

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