Healthcare Provider Details

I. General information

NPI: 1396510517
Provider Name (Legal Business Name): AMANDA MICHELE DINARDI OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA MICHELE ROBERTS OD

II. Dates (important events)

Enumeration Date: 11/17/2023
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1142 S DELANO CT W
CHICAGO IL
60605-3733
US

IV. Provider business mailing address

7208 191ST ST
TINLEY PARK IL
60487-9378
US

V. Phone/Fax

Practice location:
  • Phone: 312-583-0499
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046.011813
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: