Healthcare Provider Details

I. General information

NPI: 1700814530
Provider Name (Legal Business Name): IRENE D COMBS O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 03/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 HILLGROVE AVE
WESTERN SPRINGS IL
60558-1481
US

IV. Provider business mailing address

504 HILLGROVE AVE
WESTERN SPRINGS IL
60558-1481
US

V. Phone/Fax

Practice location:
  • Phone: 708-286-1100
  • Fax: 708-286-1103
Mailing address:
  • Phone: 708-286-1100
  • Fax: 708-286-1103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: