Healthcare Provider Details

I. General information

NPI: 1659183630
Provider Name (Legal Business Name): ATHENA COHEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2025
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 E ERIE ST STE 1520
CHICAGO IL
60611-3111
US

IV. Provider business mailing address

259 E ERIE ST STE 1520
CHICAGO IL
60611-3111
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-8150
  • Fax:
Mailing address:
  • Phone: 312-695-8150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number125087368
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: