Provider Demographics
NPI:1124011788
Name:BELLEN, BREEZE EVELYN (OD)
Entity Type:Individual
Prefix:DR
First Name:BREEZE
Middle Name:EVELYN
Last Name:BELLEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:BREEZE
Other - Middle Name:EVELYN
Other - Last Name:FEILER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:519 W MELROSE ST
Mailing Address - Street 2:APT 412
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-3764
Mailing Address - Country:US
Mailing Address - Phone:773-505-7039
Mailing Address - Fax:
Practice Address - Street 1:4740 N LINCOLN AVE
Practice Address - Street 2:FL 1
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-2247
Practice Address - Country:US
Practice Address - Phone:773-275-2900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-29
Last Update Date:2009-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046009782152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist