Healthcare Provider Details

I. General information

NPI: 1598864324
Provider Name (Legal Business Name): DR ATHA HYDERI PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 N ROSELLE RD
ROSELLE IL
60172-4212
US

IV. Provider business mailing address

833 N ROSELLE RD
ROSELLE IL
60172-4212
US

V. Phone/Fax

Practice location:
  • Phone: 630-351-0085
  • Fax: 630-351-1530
Mailing address:
  • Phone: 630-351-0085
  • Fax: 630-351-1530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License Number
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number
License Number StateIL
# 6
Primary TaxonomyN
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License Number
License Number StateIL
# 7
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. ATHA ALI HYDERI
Title or Position: OPTOMETRIST
Credential: OD
Phone: 630-351-0085