MEDICARE: DR. JAMES D. DOHERTY 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	046006829	IL

General Provider Information

NPI Number	:	1427001718
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES D. DOHERTY O.D.

Provider Business Mailing Address
First Line	:	1914 E GRAND AVE
Second Line	:
City	:	LINDENHURST
State	:	IL
Zip	:	60046-7822
Country	:	US
Telephone Number	:	847-274-6000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1914 E GRAND AVE
Second Line	:
City	:	LINDENHURST
State	:	IL
Zip	:	60046-7822
Country	:	US
Telephone Number	:	847-356-2020
Fax Number	:

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

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	05/01/2025

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