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General NPI Number Information
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NPI Number | 1922721646
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Entity Type | Individual
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Provider Name | JOSUE MORALES OD
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Gender | Male
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Dates
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Enumeration Date | 09/20/2022
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Last Update Date | 09/20/2022
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Provider Practice Location Address
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Address Line | 1101 S CANAL ST STE 108
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City | CHICAGO
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State | IL
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Zip | 60607-4940
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Country | US
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Telephone | 312-588-0159
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Fax |
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Provider Business Mailing Address
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Address Line | 7953 W 78TH ST
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City | BRIDGEVIEW
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State | IL
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Zip | 60455-1374
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Country | US
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Telephone | 708-543-9467
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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 | 046011682
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License Number State | IL
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