Individual
DR. DIYANA IVANOVA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
1950 W POLK ST, CHICAGO, IL 60612-3723
(312) 864-6000
Mailing address
1950 W POLK ST FL 8, CHICAGO, IL 60612-3723
(312) 864-6000
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046011050
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
046011050
—
IL
Enumeration date
07/29/2016
Last updated
04/26/2021
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