Individual
ABIGAIL GONSALVES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1613 E 55TH ST, CHICAGO, IL 60615-6151
(312) 363-0202
(312) 363-0201
Mailing address
1116 W TAYLOR ST, CHICAGO, IL 60607-4455
(312) 829-6173
(312) 663-4270
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046.011398
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
046.011398
ILLINOIS OPTOMETRY LICENSE
IL
Enumeration date
08/30/2019
Last updated
12/30/2024
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