Provider Demographics
NPI:1972876076
Name:GANZ PEARLMAN, LIAD (OD)
Entity type:Individual
Prefix:DR
First Name:LIAD
Middle Name:
Last Name:GANZ PEARLMAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:LIAD
Other - Middle Name:
Other - Last Name:GANZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:3547 N FREMONT ST
Mailing Address - Street 2:#1N
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-7053
Mailing Address - Country:US
Mailing Address - Phone:773-209-6251
Mailing Address - Fax:
Practice Address - Street 1:3547 N FREMONT ST
Practice Address - Street 2:#1N
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-7053
Practice Address - Country:US
Practice Address - Phone:773-209-6251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-20
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046009603152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist