Provider Demographics
NPI:1003351743
Name:NAMROOD, ALFRED
Entity Type:Individual
Prefix:
First Name:ALFRED
Middle Name:
Last Name:NAMROOD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2822 W DEVON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-1502
Mailing Address - Country:US
Mailing Address - Phone:773-338-1290
Mailing Address - Fax:773-338-1932
Practice Address - Street 1:2822 W DEVON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-1502
Practice Address - Country:US
Practice Address - Phone:773-338-1290
Practice Address - Fax:773-338-1932
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-04
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
No156FC0801XEye and Vision Services ProvidersTechnician/TechnologistContact Lens Fitter