Provider Demographics
NPI:1306270061
Name:AWAD, ABDELHAFETH (OD)
Entity type:Individual
Prefix:DR
First Name:ABDELHAFETH
Middle Name:
Last Name:AWAD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3663 S PAULINA ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60609-1222
Mailing Address - Country:US
Mailing Address - Phone:773-988-7077
Mailing Address - Fax:
Practice Address - Street 1:10900 S DOTY AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60028
Practice Address - Country:US
Practice Address - Phone:773-344-9058
Practice Address - Fax:773-468-0704
Is Sole Proprietor?:No
Enumeration Date:2013-08-29
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046010716152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist