Provider Demographics
NPI:1699905042
Name:JIMENEZ, FERNAND FELIPE (OD)
Entity type:Individual
Prefix:
First Name:FERNAND
Middle Name:FELIPE
Last Name:JIMENEZ
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 1:1111 S WABASH AVE
Mailing Address - Street 2:#2508
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-2350
Mailing Address - Country:US
Mailing Address - Phone:786-218-4744
Mailing Address - Fax:
Practice Address - Street 1:6455 S KEDZIE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-2829
Practice Address - Country:US
Practice Address - Phone:773-863-9234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-20
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046010191152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist