Provider Demographics
NPI:1366906349
Name:BELUCH, AIMEE ELIZABETH (OD)
Entity type:Individual
Prefix:DR
First Name:AIMEE
Middle Name:ELIZABETH
Last Name:BELUCH
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 1:229 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60040-1106
Mailing Address - Country:US
Mailing Address - Phone:847-436-0033
Mailing Address - Fax:
Practice Address - Street 1:6170 GRAND AVE STE 807
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-4553
Practice Address - Country:US
Practice Address - Phone:847-436-0033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-24
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046011271152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty