Healthcare Provider Details

I. General information

NPI: 1669207759
Provider Name (Legal Business Name): REEHAM TINEH OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2024
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7456 S STATE RD STE 302
BEDFORD PARK IL
60638-6625
US

IV. Provider business mailing address

8936 SILVERDALE DR
ORLAND PARK IL
60462-3382
US

V. Phone/Fax

Practice location:
  • Phone: 773-873-0052
  • Fax:
Mailing address:
  • Phone: 708-580-3898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046.011909
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: