MEDICARE: DR. CHARMI KOTHARI 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	046010683	IL
2	152W00000X	Optometrist	18004250A	IN

General Provider Information

NPI Number	:	1366882763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARMI KOTHARI O.D.

Provider Business Mailing Address
First Line	:	209 S LA SALLE ST LBBY 120
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60604-1436
Country	:	US
Telephone Number	:	312-332-4461
Fax Number	:	312-332-5970

Provider Business Practice Location Address
First Line	:	209 S LA SALLE ST LBBY 120
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60604-1436
Country	:	US
Telephone Number	:	312-332-4461
Fax Number	:	312-332-5970

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

Provider Enumeration Date	:	06/28/2013
Last Update Date	:	01/20/2026

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