Organization
LINCOLN SQUARE OPTICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARIAM ETHEZAZ OD (OPTOMETRIST)
(773) 931-3839
Entity
Organization
Contact information
Practice address
2501 W LAWRENCE AVE, CHICAGO, IL 60625-2958
(773) 931-3839
Mailing address
5232 WRIGHT TER, SKOKIE, IL 60077-2161
(773) 931-3839
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
152WC0802X
Corneal and Contact Management Optometrist
—
—
152WL0500X
Low Vision Rehabilitation Optometrist
—
—
152WP0200X
Pediatric Optometrist
—
—
152WV0400X
Vision Therapy Optometrist
—
—
Other
Enumeration date
10/23/2018
Last updated
10/23/2018
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