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General NPI Number Information
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NPI Number | 1255534137
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Entity Type | Organization
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Legal Business Name | OKSANA MENSHEHA, M.D., S.C.
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Dates
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Enumeration Date | 06/07/2007
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Last Update Date | 06/26/2008
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Provider Practice Location Address
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Address Line | 1117 S MILWAUKEE AVE FORUM SQUARE A-10
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City | LIBERTYVILLE
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State | IL
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Zip | 60048-3798
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Country | US
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Telephone | 847-367-6780
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Fax | 847-367-6861
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Provider Business Mailing Address
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Address Line | 1117 S MILWAUKEE AVE FORUM SQUARE A-10
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City | LIBERTYVILLE
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State | IL
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Zip | 60048-3798
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Country | US
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Telephone | 847-367-6780
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Fax | 847-367-6861
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Authorized Official
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Title or Position | OWNER
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Name | DR. OKSANA MENSHEHA
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Credential | M.D.
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Telephone | 847-367-6780
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 3603536
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License Number State | IL
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