Healthcare Provider Details

I. General information

NPI: 1851985121
Provider Name (Legal Business Name): TONI A. REISING O.D., LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2021
Last Update Date: 02/26/2021
Certification Date: 02/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8826 OGDEN AVE
BROOKFIELD IL
60513-2100
US

IV. Provider business mailing address

8826 OGDEN AVE
BROOKFIELD IL
60513-2100
US

V. Phone/Fax

Practice location:
  • Phone: 708-485-0411
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TONI ANN REISING
Title or Position: OWNER
Credential:
Phone: 708-485-0411