Healthcare Provider Details

I. General information

NPI: 1053202994
Provider Name (Legal Business Name): FATIMA HAIDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2025
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 E COUNTRYSIDE PKWY
YORKVILLE IL
60560-1877
US

IV. Provider business mailing address

120 E COUNTRYSIDE PKWY
YORKVILLE IL
60560-1877
US

V. Phone/Fax

Practice location:
  • Phone: 630-553-6166
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046012073
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: