Healthcare Provider Details

I. General information

NPI: 1255013850
Provider Name (Legal Business Name): MAHA JABBAR OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2023
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11600 S KEDZIE AVE
MERRIONETTE PARK IL
60803-6307
US

IV. Provider business mailing address

11600 S KEDZIE AVE STE CANDH
MERRIONETTE PARK IL
60803-6307
US

V. Phone/Fax

Practice location:
  • Phone: 773-282-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2348DT
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046.012093
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number007195
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: