Provider Demographics
NPI:1366882763
Name:SHIYARWALA, CHARMI (OD)
Entity type:Individual
Prefix:DR
First Name:CHARMI
Middle Name:
Last Name:SHIYARWALA
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 1:209 S LA SALLE ST LBBY 120
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60604-1436
Mailing Address - Country:US
Mailing Address - Phone:312-332-4461
Mailing Address - Fax:312-332-5970
Practice Address - Street 1:209 S LA SALLE ST LBBY 120
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60604-1436
Practice Address - Country:US
Practice Address - Phone:312-332-4461
Practice Address - Fax:312-332-5970
Is Sole Proprietor?:No
Enumeration Date:2013-06-28
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18004250A152W00000X
IL046010683152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist