Provider Demographics
NPI:1154730315
Name:JAWAD HAIDER OD LTD
Entity type:Organization
Organization Name:JAWAD HAIDER OD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:O.D./OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAWAD
Authorized Official - Middle Name:
Authorized Official - Last Name:HAIDER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:309-353-4220
Mailing Address - Street 1:609 DORSET CT
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-2685
Mailing Address - Country:US
Mailing Address - Phone:309-353-4220
Mailing Address - Fax:309-353-4222
Practice Address - Street 1:3320 VETERANS DR
Practice Address - Street 2:
Practice Address - City:PEKIN
Practice Address - State:IL
Practice Address - Zip Code:61554-9317
Practice Address - Country:US
Practice Address - Phone:309-353-4220
Practice Address - Fax:309-353-4222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-12
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046010634152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty