Provider Demographics
NPI:1528462660
Name:ALBATCHE, RAID JOSEPH (OD)
Entity type:Individual
Prefix:DR
First Name:RAID
Middle Name:JOSEPH
Last Name:ALBATCHE
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 1:3500 W PETERSON AVE STE 401
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-3307
Mailing Address - Country:US
Mailing Address - Phone:773-588-3090
Mailing Address - Fax:773-588-3210
Practice Address - Street 1:3500 W PETERSON AVE STE 401
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-3307
Practice Address - Country:US
Practice Address - Phone:773-588-3090
Practice Address - Fax:773-588-3210
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-17
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046.010850152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP01423830OtherRAILROAD MEDICARE
ILF400173522Medicare PIN
ILF400173524Medicare PIN
ILF400173521Medicare PIN
ILP01423830OtherRAILROAD MEDICARE