MEDICARE: DR. FOROUZANDEH ALAVI 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	046010140	IL
2	152W00000X	Optometrist	047934493	IL

General Provider Information

NPI Number	:	1740437706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FOROUZANDEH ALAVI O.D.

Provider Business Mailing Address
First Line	:	7107 W DEMPSTER ST
Second Line	:
City	:	NILES
State	:	IL
Zip	:	60714-2131
Country	:	US
Telephone Number	:	847-965-2695
Fax Number	:	847-965-0250

Provider Business Practice Location Address
First Line	:	7107 W DEMPSTER ST
Second Line	:
City	:	NILES
State	:	IL
Zip	:	60714-2131
Country	:	US
Telephone Number	:	847-965-2695
Fax Number	:	847-965-0250

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

Provider Enumeration Date	:	08/21/2008
Last Update Date	:	08/21/2008

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