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General NPI Number Information
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NPI Number | 1891775144
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Entity Type | Individual
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Provider Name | IRVE DENENBERG OD
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Gender | Male
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Dates
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Enumeration Date | 01/20/2006
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Last Update Date | 04/30/2014
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Provider Practice Location Address
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Address Line | 1020 11TH AVE
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City | GREAT LAKES
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State | IL
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Zip | 60088-3102
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Country | US
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Telephone | 847-688-7757
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Fax |
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Provider Business Mailing Address
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Address Line | 2074 MADISON AVE
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City | GURNEE
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State | IL
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Zip | 60031-6301
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Country | US
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Telephone | 847-688-5575
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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 | 152WX0102X
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Taxonomy Name | Occupational Vision Optometrist
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License Number | 2794
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License Number State | WI
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