Healthcare Provider Details

I. General information

NPI: 1154734101
Provider Name (Legal Business Name): CHRISTOPHER BANNA O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2014
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5525 W BELMONT AVE
CHICAGO IL
60641-4130
US

IV. Provider business mailing address

5525 W BELMONT AVE
CHICAGO IL
60641-4130
US

V. Phone/Fax

Practice location:
  • Phone: 773-282-1718
  • Fax:
Mailing address:
  • Phone: 773-282-1718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046.010791
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: