MEDICARE: MR. AMIT BHAMBRI 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	046010438	IL

General Provider Information

NPI Number	:	1144517020
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. AMIT BHAMBRI O.D.

Provider Business Mailing Address
First Line	:	1030 CHARLELA LN
Second Line	:	APT 202
City	:	ELK GROVE VILLAGE
State	:	IL
Zip	:	60007-7249
Country	:	US
Telephone Number	:	773-354-0239
Fax Number	:

Provider Business Practice Location Address
First Line	:	1601 N HARLEM AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60707-4303
Country	:	US
Telephone Number	:	773-836-4110
Fax Number	:	773-637-1109

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

Provider Enumeration Date	:	06/29/2011
Last Update Date	:	11/21/2013

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