Individual
MARY FAZELIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
7305 W IRVING PARK RD, CHICAGO, IL 60634-3547
(847) 722-8319
Mailing address
5710 LEE ST, MORTON GROVE, IL 60053-3117
(847) 722-8319
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046009825
IL
152WX0102X
Occupational Vision Optometrist
3190 AT
OR
Other
Enumeration date
03/26/2007
Last updated
05/22/2012
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