MEDICARE: ANITA LATGNOTHA OD

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	046011743	IL

General Provider Information

NPI Number	:	1235812322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANITA LATGNOTHA OD

Provider Business Mailing Address
First Line	:	303 APPLE HILL LN
Second Line	:
City	:	STREAMWOOD
State	:	IL
Zip	:	60107-1058
Country	:	US
Telephone Number	:	630-550-7420
Fax Number	:

Provider Business Practice Location Address
First Line	:	2663 N ELSTON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-2018
Country	:	US
Telephone Number	:	773-394-7029
Fax Number	:

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

Provider Enumeration Date	:	08/07/2023
Last Update Date	:	08/07/2023

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