Healthcare Provider Details

I. General information

NPI: 1689265373
Provider Name (Legal Business Name): AZALEA GARCIA OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2021
Last Update Date: 07/07/2025
Certification Date: 07/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

4012 W 91ST PL
OAK LAWN IL
60453-1902
US

V. Phone/Fax

Practice location:
  • Phone: 708-636-9393
  • Fax:
Mailing address:
  • Phone: 773-450-0871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046011491
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: