MEDICARE: DR. SALEEM AHMAD 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	046.008543	IL

General Provider Information

NPI Number	:	1265628762
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SALEEM AHMAD OD

Provider Business Mailing Address
First Line	:	6647 MAJESTIC WAY
Second Line	:
City	:	CARPENTERSVILLE
State	:	IL
Zip	:	60110-3438
Country	:	US
Telephone Number	:	847-844-9860
Fax Number	:

Provider Business Practice Location Address
First Line	:	4234 S ARCHER AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60632-2550
Country	:	US
Telephone Number	:	773-254-6800
Fax Number	:

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

Provider Enumeration Date	:	09/18/2007
Last Update Date	:	06/15/2011

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