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Individual

CHRISTINE DISALVOOST

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
OD

Contact information

Practice address
10001 W 143RD ST, ORLAND PARK, IL 60462-2026
(708) 349-2600
(708) 349-9201
Mailing address
10001 W 143RD ST, ORLAND PARK, IL 60462-2026
(708) 349-2600
(708) 349-9201

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046008134
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0363241858
TAX ID OAK LAWN
IL
01
0363448367
TAX ID ORLAND PARK
IL
01
0410017240
RR MEDICARE IND ORLAND
IL
01
0618250001
DME OAKLAWN
IL
01
0990005851
RR MEDICARE IND.OAKLAWN
IL
01
1148260001
DME ORLAND PARK
IL
01
508980
MEDICARE PROVIDER OL
IL
01
985800
MEDICARE PROVIDER OP
IL
01
CN3870
RR MEDICARE GRP OL
IL
01
DA8522
RR MEDICARE GRP OP
IL
Enumeration date
05/11/2006
Last updated
02/10/2010
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