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General NPI Number Information
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NPI Number | 1386124089
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Entity Type | Individual
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Provider Name | JEANNIE XIE OD
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Gender | Female
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Dates
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Enumeration Date | 08/21/2018
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Last Update Date | 08/21/2018
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Provider Practice Location Address
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Address Line | 4214 N HARLEM AVE
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City | NORRIDGE
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State | IL
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Zip | 60706-1293
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Country | US
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Telephone | 708-453-7005
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Fax |
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Provider Business Mailing Address
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Address Line | 3700 N MONTICELLO AVE
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City | CHICAGO
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State | IL
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Zip | 60618-4118
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Country | US
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Telephone | 312-282-7979
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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 | 046.011238
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License Number State | IL
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