Healthcare Provider Details

I. General information

NPI: 1568569853
Provider Name (Legal Business Name): MARGARET MARY MANNION O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 E HURON ST. VA MEDICAL CENTER
CHICAGO IL
60611
US

IV. Provider business mailing address

2420 N SOUTHPORT AVE APT 2R
CHICAGO IL
60614-2163
US

V. Phone/Fax

Practice location:
  • Phone: 312-469-3229
  • Fax:
Mailing address:
  • Phone: 312-636-9769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberMM1242457
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number18002669B
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: