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NPI Code Detail

MEDICARE: JANICE M MCMAHON OD

MEDICARE: JANICE M MCMAHON 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
1152W00000XOptometrist046009119IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1760475297
Entity Type Code : Individual
Provider Name (Legal Business Name) : JANICE M MCMAHON OD
Provider Business Mailing Address
First Line : 3241 S MICHIGAN AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60616-3849
Country : US
Telephone Number : 312-949-7323
Fax Number : 312-949-7642
Provider Business Practice Location Address
First Line : 3241 S MICHIGAN AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60616-3849
Country : US
Telephone Number : 312-949-7323
Fax Number : 312-949-7642
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/30/2005
Last Update Date : 01/20/2012

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Directions to “ JANICE M MCMAHON OD” Practice Location

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