Provider Demographics
NPI:1487932323
Name:AFREEN, SADIA (OD)
Entity type:Individual
Prefix:
First Name:SADIA
Middle Name:
Last Name:AFREEN
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 1:1629 S MICHIGAN AVE APT 305
Mailing Address - Street 2:
Mailing Address - City:VILLA PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60181-4101
Mailing Address - Country:US
Mailing Address - Phone:408-712-8922
Mailing Address - Fax:
Practice Address - Street 1:8617 S COTTAGE GROVE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-6107
Practice Address - Country:US
Practice Address - Phone:773-651-7106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-26
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046010532152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist