Healthcare Provider Details

I. General information

NPI: 1124068572
Provider Name (Legal Business Name): DEANA R LABROSSE O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 01/21/2024
Certification Date: 01/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1604 W CENTRAL RD
ARLINGTON HEIGHTS IL
60005-2407
US

IV. Provider business mailing address

1700 GLENVIEW AVE
PARK RIDGE IL
60068-1712
US

V. Phone/Fax

Practice location:
  • Phone: 847-394-1414
  • Fax: 847-418-8928
Mailing address:
  • Phone: 847-840-3216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number046009750
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number046009750
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number046009750
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046009750
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: