Provider Demographics
NPI:1114181153
Name:HABIB, ROGER (OD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:
Last Name:HABIB
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 N LASALLE ST APT 10K
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-7605
Mailing Address - Country:US
Mailing Address - Phone:312-388-1711
Mailing Address - Fax:
Practice Address - Street 1:2730 N CLARK ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-1503
Practice Address - Country:US
Practice Address - Phone:773-868-9189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046010133152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist