Healthcare Provider Details

I. General information

NPI: 1679721997
Provider Name (Legal Business Name): GEORGE G PAPPAS O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2008
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
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 TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046010134
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: