Provider Demographics
NPI:1164533394
Name:PEARSON, ANITA ELAINE (OD)
Entity Type:Individual
Prefix:DR
First Name:ANITA
Middle Name:ELAINE
Last Name:PEARSON
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 1:7729 VIRGINIA CT
Mailing Address - Street 2:
Mailing Address - City:WILLOWBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527-2617
Mailing Address - Country:US
Mailing Address - Phone:630-850-9383
Mailing Address - Fax:
Practice Address - Street 1:10260 S HARLEM AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEVIEW
Practice Address - State:IL
Practice Address - Zip Code:60455-2401
Practice Address - Country:US
Practice Address - Phone:708-499-2988
Practice Address - Fax:708-499-3057
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management