Provider Demographics
NPI:1043885007
Name:DELTAVISIONINC
Entity Type:Organization
Organization Name:DELTAVISIONINC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ZEHRA
Authorized Official - Middle Name:
Authorized Official - Last Name:JAFFERI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:708-212-6738
Mailing Address - Street 1:965 OAKHURST LN
Mailing Address - Street 2:
Mailing Address - City:RIVERWOODS
Mailing Address - State:IL
Mailing Address - Zip Code:60015-2513
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2939 W ADDISON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-4635
Practice Address - Country:US
Practice Address - Phone:773-250-0002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-23
Last Update Date:2021-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care