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General NPI Number Information
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NPI Number | 1154389963
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Entity Type | Individual
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Provider Name | AMNA MIRZA MALIK O.D.
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Gender | Female
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Dates
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Enumeration Date | 05/02/2006
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Last Update Date | 05/27/2014
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Provider Practice Location Address
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Address Line | 750 S RANDALL RD
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City | ALGONQUIN
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State | IL
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Zip | 60102-5915
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Country | US
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Telephone | 847-458-5343
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Fax | 847-458-4344
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Provider Business Mailing Address
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Address Line | 10883 CONCORD LN
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City | HUNTLEY
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State | IL
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Zip | 60142-4041
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Country | US
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Telephone | 832-641-3351
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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 | 046010021
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License Number State | IL
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