Provider Demographics
NPI:1043227168
Name:GAFOUR, EIMAN YOUSIF (OD)
Entity Type:Individual
Prefix:
First Name:EIMAN
Middle Name:YOUSIF
Last Name:GAFOUR
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 1:3448 N MONTICELLO AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-5356
Mailing Address - Country:US
Mailing Address - Phone:312-342-7007
Mailing Address - Fax:708-552-9017
Practice Address - Street 1:12812 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:BLUE ISLAND
Practice Address - State:IL
Practice Address - Zip Code:60406-2118
Practice Address - Country:US
Practice Address - Phone:708-385-0013
Practice Address - Fax:708-385-1175
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046009572152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00178341OtherRAILROAD MCR
IL046009572Medicaid
IL046009572Medicaid
ILK13917Medicare ID - Type Unspecified
ILK13918Medicare ID - Type Unspecified
ILK13915Medicare ID - Type Unspecified
ILK13916Medicare ID - Type Unspecified