Healthcare Provider Details

I. General information

NPI: 1346779147
Provider Name (Legal Business Name): AMBER FATIMA NAQVI OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMBER FATIMA SHAH OD

II. Dates (important events)

Enumeration Date: 06/06/2017
Last Update Date: 05/23/2025
Certification Date: 05/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3241 S MICHIGAN AVE
CHICAGO IL
60616-4201
US

IV. Provider business mailing address

8038 MACINTOSH LN
ROCKFORD IL
61107-5336
US

V. Phone/Fax

Practice location:
  • Phone: 312-225-6200
  • Fax:
Mailing address:
  • Phone: 815-332-6800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046.011496
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number008568
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number34213TLG
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number046.011496
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: