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Individual

HEATHER MIRA MCLEOD

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
O.D.

Contact information

Practice address
3241 S MICHIGAN AVE, CHICAGO, IL 60616-3878
(312) 225-6200
(312) 949-7389
Mailing address
3241 S MICHIGAN AVE, CHICAGO, IL 60616-3878
(312) 225-6200
(312) 949-7389

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046009856
IL
152W00000X
Optometrist
TUV007063
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
046009856
IL
01
502720032
MEDICARE PTAN
IL
01
P01010750
RAILROAD MEDICARE
IL
Enumeration date
08/25/2006
Last updated
09/05/2012
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