Healthcare Provider Details

I. General information

NPI: 1508394933
Provider Name (Legal Business Name): AWAD EYECARE SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2017
Last Update Date: 12/23/2020
Certification Date: 12/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1845 S MICHIGAN AVE UNIT 1803
CHICAGO IL
60616
US

IV. Provider business mailing address

22955 FOLKESTONE WAY
FRANKFORT IL
60423-1703
US

V. Phone/Fax

Practice location:
  • Phone: 773-988-7077
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046010716
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number046010716
License Number StateIL

VIII. Authorized Official

Name: DR. ABDELHAFETH AWAD
Title or Position: OWNER OPTOMETRIST
Credential: OD
Phone: 773-988-7077