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General NPI Number Information
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NPI Number | 1184986093
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Entity Type | Individual
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Provider Name | SNEZHANA BELUKOV SABO O.D.
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Gender | Female
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Dates
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Enumeration Date | 06/15/2012
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Last Update Date | 11/19/2013
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Provider Practice Location Address
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Address Line | 6141 N LINCOLN AVE
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City | CHICAGO
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State | IL
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Zip | 60659-2313
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Country | US
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Telephone | 773-596-5651
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Fax |
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Provider Business Mailing Address
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Address Line | 1373 NEWPORT ST
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City | MUNDELEIN
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State | IL
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Zip | 60060-4626
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Country | US
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Telephone |
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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 | 046010551
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License Number State | IL
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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 | 327835
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License Number State | WI
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