Healthcare Provider Details

I. General information

NPI: 1851308944
Provider Name (Legal Business Name): CHRISTOPHER M SUOR O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 11/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10550 S CICERO AVE
OAK LAWN IL
60453-5267
US

IV. Provider business mailing address

10550 S CICERO AVE
OAK LAWN IL
60453-5267
US

V. Phone/Fax

Practice location:
  • Phone: 708-499-3911
  • Fax:
Mailing address:
  • Phone: 708-499-3911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046007528
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: