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General NPI Number Information
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NPI Number | 1366882763
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Entity Type | Individual
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Provider Name | CHARMI SHIYARWALA O.D.
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Gender | Female
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Dates
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Enumeration Date | 06/28/2013
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Last Update Date | 01/08/2025
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Provider Practice Location Address
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Address Line | 209 S LA SALLE ST LBBY 120
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City | CHICAGO
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State | IL
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Zip | 60604-1436
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Country | US
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Telephone | 312-332-4461
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Fax | 312-332-5970
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Provider Business Mailing Address
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Address Line | 209 S LA SALLE ST LBBY 120
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City | CHICAGO
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State | IL
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Zip | 60604-1436
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Country | US
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Telephone | 312-332-4461
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Fax | 312-332-5970
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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 | 18004250A
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License Number State | IN
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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 | 046010683
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License Number State | IL
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