=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114157492
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EMMA LOYFMAN ODPC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/21/2009
-----------------------------------------------------
Last Update Date | 04/22/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3144 BROADWAY
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60065
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-880-5400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3144 N BROADWAY
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60657
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-880-5400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. EMMA LOYFMAN
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 773-880-5400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 046009774
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------