Healthcare Provider Details

I. General information

NPI: 1114157492
Provider Name (Legal Business Name): EMMA LOYFMAN ODPC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2009
Last Update Date: 04/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3144 BROADWAY
CHICAGO IL
60065
US

IV. Provider business mailing address

3144 N BROADWAY
CHICAGO IL
60657
US

V. Phone/Fax

Practice location:
  • Phone: 773-880-5400
  • Fax:
Mailing address:
  • Phone: 773-880-5400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046009774
License Number StateIL

VIII. Authorized Official

Name: DR. EMMA LOYFMAN
Title or Position: PRESIDENT
Credential: O.D.
Phone: 773-880-5400