Provider Demographics
NPI:1972626240
Name:TAHIR, MUBASHRA S (OD)
Entity type:Individual
Prefix:DR
First Name:MUBASHRA
Middle Name:S
Last Name:TAHIR
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:119 79TH ST
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-5954
Mailing Address - Country:US
Mailing Address - Phone:630-789-9262
Mailing Address - Fax:630-789-9268
Practice Address - Street 1:4837 CAL SAG RD
Practice Address - Street 2:
Practice Address - City:CRESTWOOD
Practice Address - State:IL
Practice Address - Zip Code:60445-4415
Practice Address - Country:US
Practice Address - Phone:708-489-2020
Practice Address - Fax:708-489-5122
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist