Healthcare Provider Details

I. General information

NPI: 1437590411
Provider Name (Legal Business Name): ANGELA MARIE BENKESER OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2013
Last Update Date: 01/10/2024
Certification Date: 01/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 N MICHIGAN AVE STE 210
CHICAGO IL
60611
US

IV. Provider business mailing address

3057 W WILSON AVE APT 1
CHICAGO IL
60625-4344
US

V. Phone/Fax

Practice location:
  • Phone: 312-787-2020
  • Fax:
Mailing address:
  • Phone: 630-707-0405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number046.011049
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046.011049
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: