Individual
TEA DIMO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4628 N OZARK AVE, NORRIDGE, IL 60706-4527
(773) 829-6355
Mailing address
4628 N OZARK AVE, NORRIDGE, IL 60706-4527
(773) 829-6355
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046011815
IL
Other
Enumeration date
12/07/2023
Last updated
12/07/2023
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