Healthcare Provider Details

I. General information

NPI: 1437446333
Provider Name (Legal Business Name): RAMAN BHAKHRI O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2011
Last Update Date: 03/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3241 S MICHIGAN AVE
CHICAGO IL
60616-3878
US

IV. Provider business mailing address

3241 S MICHIGAN AVE
CHICAGO IL
60616-3878
US

V. Phone/Fax

Practice location:
  • Phone: 312-949-7211
  • Fax: 312-949-7389
Mailing address:
  • Phone: 312-949-7211
  • Fax: 312-949-7389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number046010430
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046010430
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: