Provider Demographics
NPI:1124011788
Name:BELLEN, BREEZE EVELYN (OD)
Entity type:Individual
Prefix:DR
First Name:BREEZE
Middle Name:EVELYN
Last Name:BELLEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:BREEZE
Other - Middle Name:EVELYN
Other - Last Name:FEILER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:350 S NORTHWEST HWY STE 104
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-4262
Mailing Address - Country:US
Mailing Address - Phone:847-823-8283
Mailing Address - Fax:
Practice Address - Street 1:350 S NORTHWEST HWY STE 104
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-4262
Practice Address - Country:US
Practice Address - Phone:847-823-8283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-29
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046009782152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist