Individual
LAUREN RISTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
820 S DAMEN AVE, 170F, CHICAGO, IL 60612-3728
(312) 569-7501
Mailing address
1600 BROPHY AVE, PARK RIDGE, IL 60068-5234
(847) 698-2026
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046-009889
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
212593001
MEDICARE PTAN
IL
Enumeration date
10/11/2006
Last updated
01/11/2011
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