Provider Demographics
NPI:1346084589
Name:IZZA PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:IZZA PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANNUM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:773-322-7071
Mailing Address - Street 1:3092 SERENITY LN
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-4669
Mailing Address - Country:US
Mailing Address - Phone:773-322-7071
Mailing Address - Fax:
Practice Address - Street 1:4931 S ROUTE 59 STE 115
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-2692
Practice Address - Country:US
Practice Address - Phone:630-904-1900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-22
Last Update Date:2024-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty