Provider Demographics
NPI:1306122270
Name:ALMODOVAR, JORGE J (OD)
Entity type:Individual
Prefix:DR
First Name:JORGE
Middle Name:J
Last Name:ALMODOVAR
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:6170 GRAND AVE
Mailing Address - Street 2:SUITE 155
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-4592
Mailing Address - Country:US
Mailing Address - Phone:847-356-2900
Mailing Address - Fax:847-356-5051
Practice Address - Street 1:6170 GRAND AVE
Practice Address - Street 2:SUITE 155
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-4592
Practice Address - Country:US
Practice Address - Phone:847-356-2900
Practice Address - Fax:847-356-5051
Is Sole Proprietor?:No
Enumeration Date:2011-10-24
Last Update Date:2011-10-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL046010502152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist