Healthcare Provider Details

I. General information

NPI: 1871018036
Provider Name (Legal Business Name): HOLLY LE OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2017
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6209 W 95TH ST
OAK LAWN IL
60453-2701
US

IV. Provider business mailing address

6209 W 95TH ST
OAK LAWN IL
60453-2701
US

V. Phone/Fax

Practice location:
  • Phone: 708-423-2500
  • Fax: 708-423-2845
Mailing address:
  • Phone: 708-423-2500
  • Fax: 708-423-2845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046.011128
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: