=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659459857
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EIRIT YONATAN OD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/02/2006
-----------------------------------------------------
Last Update Date | 04/01/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1717 W GOLF RD
-----------------------------------------------------
City | MT PROSPECT
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60056
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-937-1414
-----------------------------------------------------
Fax | 847-437-9763
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1250 FERNDALE AVE
-----------------------------------------------------
City | HIGHLAND PARK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60035
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-579-0880
-----------------------------------------------------
Fax | 847-831-3652
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------