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General NPI Number Information
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NPI Number | 1104233436
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Entity Type | Individual
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Provider Name | GENNA HIGBEE OD
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Gender | Female
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Dates
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Enumeration Date | 07/18/2014
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Last Update Date | 03/21/2018
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Provider Practice Location Address
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Address Line | 607 N STATE ST
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City | CHICAGO
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State | IL
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Zip | 60654-3834
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Country | US
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Telephone | 312-929-3720
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Fax |
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Provider Business Mailing Address
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Address Line | 400 E SOUTH WATER ST APT 2905
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City | CHICAGO
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State | IL
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Zip | 60601-4066
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Country | US
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Telephone | 330-506-5699
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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 | OEG002979
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 046.010910
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License Number State | IL
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