Healthcare Provider Details

I. General information

NPI: 1306829601
Provider Name (Legal Business Name): DENNIS DELEE O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 01/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 S LASALLE ST STE. 120
CHICAGO IL
60604-1219
US

IV. Provider business mailing address

209 S LASALLE ST STE. 120
CHICAGO IL
60604-1219
US

V. Phone/Fax

Practice location:
  • Phone: 312-332-4461
  • Fax: 312-332-4461
Mailing address:
  • Phone: 312-332-4461
  • Fax: 312-332-4461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number46-006526
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: