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General NPI Number Information
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NPI Number | 1093851487
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Entity Type | Organization
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Legal Business Name | DRS. LEAHY & DISALVO-OST, P.C.
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 08/17/2018
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Provider Practice Location Address
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Address Line | 4445 W 95TH ST
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City | OAK LAWN
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State | IL
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Zip | 60453-7219
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Country | US
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Telephone | 708-425-6500
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Fax | 708-425-1455
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Provider Business Mailing Address
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Address Line | 4445 W 95TH ST
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City | OAK LAWN
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State | IL
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Zip | 60453-7219
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Country | US
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Telephone | 708-425-6500
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Fax | 708-425-1455
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Authorized Official
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Title or Position | MANAGER
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Name | MARGARET E. PAWELSKI
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Credential |
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Telephone | 708-425-6500
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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 | 060.003768
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License Number State | IL
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