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General NPI Number Information
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NPI Number | 1508394933
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Entity Type | Organization
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Legal Business Name | AWAD EYECARE SC
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Dates
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Enumeration Date | 05/30/2017
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Last Update Date | 12/23/2020
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Provider Practice Location Address
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Address Line | 1845 S MICHIGAN AVE UNIT 1803
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City | CHICAGO
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State | IL
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Zip | 60616
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Country | US
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Telephone | 773-988-7077
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Fax |
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Provider Business Mailing Address
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Address Line | 22955 FOLKESTONE WAY
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City | FRANKFORT
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State | IL
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Zip | 60423-1703
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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 | OWNER OPTOMETRIST
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Name | DR. ABDELHAFETH AWAD
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Credential | OD
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Telephone | 773-988-7077
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 046010716
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License Number State | IL
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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 | 046010716
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License Number State | IL
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