Provider Demographics
NPI:1215253257
Name:MOBINI, PARISA (OD)
Entity type:Individual
Prefix:
First Name:PARISA
Middle Name:
Last Name:MOBINI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6455 S KEDZIE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60629-2829
Mailing Address - Country:US
Mailing Address - Phone:773-863-9234
Mailing Address - Fax:
Practice Address - Street 1:6455 S KEDZIE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-2829
Practice Address - Country:US
Practice Address - Phone:773-863-9234
Practice Address - Fax:773-863-9274
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-15
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046010216152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist