Healthcare Provider Details

I. General information

NPI: 1912976044
Provider Name (Legal Business Name): MARIANNA BILIS O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 03/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 W PETERSON AVE SUITE 401
CHICAGO IL
60659-3306
US

IV. Provider business mailing address

3917 CHARLIE CT
GLENVIEW IL
60026
US

V. Phone/Fax

Practice location:
  • Phone: 773-588-3090
  • Fax: 773-588-3210
Mailing address:
  • Phone: 773-792-1011
  • Fax: 773-889-0224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046008924
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: