Provider Demographics
NPI:1043590706
Name:BIRGIN, ANNA (OD)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:BIRGIN
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 1:2428 LEXINGTON DR
Mailing Address - Street 2:
Mailing Address - City:LONG GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60047-5010
Mailing Address - Country:US
Mailing Address - Phone:847-858-5392
Mailing Address - Fax:
Practice Address - Street 1:506 HAWTHORNE CTR
Practice Address - Street 2:
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1510
Practice Address - Country:US
Practice Address - Phone:847-816-1191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-25
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046.010490152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist