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General NPI Number Information
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NPI Number | 1154730315
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Entity Type | Organization
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Legal Business Name | JAWAD HAIDER OD LTD
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Dates
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Enumeration Date | 08/12/2014
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Last Update Date | 08/12/2014
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Provider Practice Location Address
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Address Line | 3320 VETERANS DR
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City | PEKIN
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State | IL
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Zip | 61554-9317
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Country | US
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Telephone | 309-353-4220
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Fax | 309-353-4222
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Provider Business Mailing Address
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Address Line | 609 DORSET CT
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City | WHEELING
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State | IL
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Zip | 60090-2685
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Country | US
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Telephone | 309-353-4220
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Fax | 309-353-4222
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Authorized Official
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Title or Position | O.D./OWNER
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Name | JAWAD HAIDER
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Credential | O.D.
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Telephone | 309-353-4220
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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 | 046010634
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License Number State | IL
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