Healthcare Provider Details

I. General information

NPI: 1255560413
Provider Name (Legal Business Name): MUJAHID SAEED O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2009
Last Update Date: 04/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 N ADDISON RD
VILLA PARK IL
60181-1419
US

IV. Provider business mailing address

4700 W 95TH ST SUITE # 102
OAK LAWN IL
60453-2533
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 Number046010265
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: