Healthcare Provider Details

I. General information

NPI: 1487229209
Provider Name (Legal Business Name): FAQAR SALEH OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2021
Last Update Date: 05/24/2021
Certification Date: 05/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8525 S HARLEM AVE
BURBANK IL
60459-2293
US

IV. Provider business mailing address

8525 S HARLEM AVE
BURBANK IL
60459-2293
US

V. Phone/Fax

Practice location:
  • Phone: 708-599-0050
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046011504
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: