=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962955856
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ZAINAB HASAN O.D
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/27/2016
-----------------------------------------------------
Last Update Date | 07/27/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1004 NORTHBROOK CT
-----------------------------------------------------
City | NORTHBROOK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60062-1403
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-564-0020
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 152 BRIGHTON 10TH ST
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11235-5301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-232-7543
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 046011057
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------