Provider Demographics
NPI:1194103770
Name:DR. IMRAN ALI P.C.
Entity type:Organization
Organization Name:DR. IMRAN ALI P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IMRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:847-312-2733
Mailing Address - Street 1:187 W IRVING PARK RD
Mailing Address - Street 2:
Mailing Address - City:ROSELLE
Mailing Address - State:IL
Mailing Address - Zip Code:60172-1119
Mailing Address - Country:US
Mailing Address - Phone:630-529-7420
Mailing Address - Fax:630-529-0512
Practice Address - Street 1:187 W IRVING PARK RD
Practice Address - Street 2:
Practice Address - City:ROSELLE
Practice Address - State:IL
Practice Address - Zip Code:60172-1119
Practice Address - Country:US
Practice Address - Phone:630-529-7420
Practice Address - Fax:630-529-0512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-14
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046010257152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty