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General NPI Number Information
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NPI Number | 1679769574
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Entity Type | Organization
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Legal Business Name | DR STANLEY DUSHMAN OD LTD
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Dates
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Enumeration Date | 09/25/2007
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 1671 MISSON HILLS ROAD #302
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City | NORTH BROOK
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State | IL
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Zip | 60062-5733
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Country | US
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Telephone | 847-800-6691
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Fax | 847-272-1735
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Provider Business Mailing Address
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Address Line | 1671 MISSON HILLS ROAD #302
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City | NORTH BROOK
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State | IL
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Zip | 60062-5733
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Country | US
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Telephone | 847-800-6691
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Fax | 847-272-1735
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Authorized Official
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Title or Position | PRES
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Name | DR. STANLEY D DUSHMAN
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Credential | OD
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Telephone | 847-800-6691
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 046005878
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License Number State | IL
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