Healthcare Provider Details

I. General information

NPI: 1699776203
Provider Name (Legal Business Name): CESAR L LAU O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2005
Last Update Date: 09/20/2024
Certification Date: 09/20/2024
Deactivation Date: 05/10/2006
Reactivation Date: 05/18/2006

III. Provider practice location address

4968 N MILWAUKEE AVE UNIT 1 S
CHICAGO IL
60630-2383
US

IV. Provider business mailing address

4968 N MILWAUKEE AVE UNIT 1 S
CHICAGO IL
60630-2383
US

V. Phone/Fax

Practice location:
  • Phone: 773-283-4053
  • Fax: 773-283-4588
Mailing address:
  • Phone: 773-283-4053
  • Fax: 773-283-4588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number046-008646
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number046-008646
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: