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General NPI Number Information
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NPI Number | 1043612807
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Entity Type | Individual
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Provider Name | MEHAR GANI ASIM O.D.
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Gender | Female
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Dates
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Enumeration Date | 09/23/2014
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Last Update Date | 01/14/2021
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Provider Practice Location Address
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Address Line | 215 W 23RD ST
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City | CHICAGO
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State | IL
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Zip | 60616-1903
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Country | US
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Telephone | 312-225-3188
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Fax |
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Provider Business Mailing Address
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Address Line | 3708 N SOUTHPORT AVE
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City | CHICAGO
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State | IL
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Zip | 60613-6888
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Country | US
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Telephone | 630-442-9850
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 046010849
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License Number State | IL
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