Provider Demographics
NPI:1023537750
Name:BUSAILEH, HANAN (OD)
Entity Type:Individual
Prefix:
First Name:HANAN
Middle Name:
Last Name:BUSAILEH
Suffix:
Gender:F
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:PO BOX 713260
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-1260
Mailing Address - Country:US
Mailing Address - Phone:630-469-9200
Mailing Address - Fax:
Practice Address - Street 1:330 MADISON ST STE 202
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-5683
Practice Address - Country:US
Practice Address - Phone:815-314-5146
Practice Address - Fax:815-314-5147
Is Sole Proprietor?:No
Enumeration Date:2017-09-13
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOPT.006596152W00000X
IN18004075A152W00000X
IL046011223152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist