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General NPI Number Information
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NPI Number | 1235789884
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Entity Type | Individual
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Provider Name | COURTNEY BANDEMER OD
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Gender | Female
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Dates
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Enumeration Date | 09/16/2019
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Last Update Date | 09/13/2024
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Provider Practice Location Address
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Address Line | 10436 SOUTHWEST HWY # 1
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City | CHICAGO RIDGE
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State | IL
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Zip | 60415-2282
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Country | US
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Telephone | 708-873-0088
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Fax | 708-423-4216
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Provider Business Mailing Address
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Address Line | 721 W BRIAR PL APT 1F
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City | CHICAGO
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State | IL
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Zip | 60657-4978
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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 | 046.011342
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License Number State | IL
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