Provider Demographics
NPI:1114023785
Name:MARMUR, VIKTORIYA (OD)
Entity Type:Individual
Prefix:DR
First Name:VIKTORIYA
Middle Name:
Last Name:MARMUR
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 1:70 W BURTON PL APT 1206
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-1468
Mailing Address - Country:US
Mailing Address - Phone:224-595-0595
Mailing Address - Fax:
Practice Address - Street 1:2734 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-1362
Practice Address - Country:US
Practice Address - Phone:773-862-5000
Practice Address - Fax:773-862-5059
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist