Healthcare Provider Details

I. General information

NPI: 1194561431
Provider Name (Legal Business Name): IBRAHIM F MOHSIN OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2024
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6201 W 95TH ST
OAK LAWN IL
60453-2701
US

IV. Provider business mailing address

1312 S FINLEY RD APT 2J
LOMBARD IL
60148-4342
US

V. Phone/Fax

Practice location:
  • Phone: 708-636-9393
  • Fax: 708-636-2022
Mailing address:
  • Phone: 630-290-5116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046.011861
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: