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General NPI Number Information
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NPI Number | 1548422686
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Entity Type | Individual
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Provider Name | TONI ANN REISING O.D.
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Gender | Female
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Dates
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Enumeration Date | 06/30/2008
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Last Update Date | 09/24/2013
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Provider Practice Location Address
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Address Line | 22 W HARRIS AVE
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City | LA GRANGE
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State | IL
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Zip | 60525-2332
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Country | US
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Telephone | 708-639-4270
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Fax | 708-639-4271
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Provider Business Mailing Address
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Address Line | 2240 W MADISON ST UNIT 201
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City | CHICAGO
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State | IL
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Zip | 60612-2375
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Country | US
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Telephone | 812-568-2471
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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 | 046010097
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License Number State | IL
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