MEDICARE: ANITA HAN OPTOMETRY, LLC

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	046010088	IL

General Provider Information

NPI Number	:	1326466764
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANITA HAN OPTOMETRY, LLC

Provider Business Mailing Address
First Line	:	2013 MILWAUKEE AVE
Second Line	:
City	:	RIVERWOODS
State	:	IL
Zip	:	60015-3581
Country	:	US
Telephone Number	:	224-676-1022
Fax Number	:	224-676-2050

Provider Business Practice Location Address
First Line	:	2013 MILWAUKEE AVE
Second Line	:
City	:	RIVERWOODS
State	:	IL
Zip	:	60015-3581
Country	:	US
Telephone Number	:	224-676-1022
Fax Number	:	224-676-2050

Authorized Official
Title or Position	:	OPTOMETRIST/OWNER
Name	:	DR. ANITA MI-YOUNG HAN
Credential	:	OD
Telephone Number	:	224-676-1022

Provider Enumeration Date	:	04/02/2014
Last Update Date	:	01/26/2018

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