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General NPI Number Information
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NPI Number | 1427148915
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Entity Type | Individual
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Provider Name | SHIRA MAZAL GELB O.D.
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Gender | Female
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 09/30/2011
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Provider Practice Location Address
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Address Line | 3104 W DEVON AVE
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City | CHICAGO
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State | IL
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Zip | 60659-1408
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Country | US
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Telephone | 773-719-3827
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Fax |
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Provider Business Mailing Address
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Address Line | 1973 BURR OAK LN
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City | HIGHLAND PARK
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State | IL
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Zip | 60035-4201
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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 | 046-009648
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License Number State | IL
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