MEDICARE: SOFIA N SYED O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	046010083	IL

General Provider Information

NPI Number	:	1053577577
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOFIA N SYED O.D.

Provider Business Mailing Address
First Line	:	1520 SPRING HILL MALL
Second Line	:
City	:	WEST DUNDEE
State	:	IL
Zip	:	60118-1266
Country	:	US
Telephone Number	:	847-426-3198
Fax Number	:

Provider Business Practice Location Address
First Line	:	1520 SPRING HILL MALL
Second Line	:
City	:	WEST DUNDEE
State	:	IL
Zip	:	60118-1266
Country	:	US
Telephone Number	:	847-426-3198
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2008
Last Update Date	:	08/04/2008

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