Provider Demographics
NPI:1184634180
Name:AAL, MARVIN (OD)
Entity Type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:
Last Name:AAL
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 1:1155 N DEARBORN ST
Mailing Address - Street 2:803
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-3421
Mailing Address - Country:US
Mailing Address - Phone:312-751-0029
Mailing Address - Fax:
Practice Address - Street 1:1155 N DEARBORN ST
Practice Address - Street 2:803
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-3421
Practice Address - Country:US
Practice Address - Phone:312-751-0029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1260152W00000X
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP15902Medicare ID - Type Unspecified