Healthcare Provider Details

I. General information

NPI: 1760725923
Provider Name (Legal Business Name): HARIS DZUBUR O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2013
Last Update Date: 01/07/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6201 W 95TH ST
OAK LAWN IL
60453-3888
US

IV. Provider business mailing address

6201 W 95TH ST
OAK LAWN IL
60453-3888
US

V. Phone/Fax

Practice location:
  • Phone: 708-636-9393
  • Fax: 708-636-2022
Mailing address:
  • Phone: 708-636-9393
  • Fax: 708-636-2022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License Number046010766
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number046010766
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: