Healthcare Provider Details

I. General information

NPI: 1730252230
Provider Name (Legal Business Name): FAMILY EYE PHYSICIANS, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 02/16/2023
Certification Date: 02/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

6201 W 95TH ST
OAK LAWN IL
60453-2701
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 Code152W00000X
TaxonomyOptometrist
License Number046009744
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number036103747
License Number StateIL

VIII. Authorized Official

Name: MOHAMMAD AL-KHUDARI
Title or Position: PRESIDENT
Credential: MD
Phone: 708-636-9393