Healthcare Provider Details

I. General information

NPI: 1568246742
Provider Name (Legal Business Name): PAIGE BOWERS OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PAIGE MALINOWSKI

II. Dates (important events)

Enumeration Date: 08/21/2023
Last Update Date: 11/25/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4445 W IRVING PARK RD STE 330
CHICAGO IL
60641-2808
US

IV. Provider business mailing address

800 SOUTH RD
LISLE IL
60532-2647
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-8150
  • Fax: 312-921-0385
Mailing address:
  • Phone: 815-219-9170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046.011758
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: