Provider Demographics
NPI:1235812322
Name:LATGNOTHA, ANITA (OD)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:LATGNOTHA
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 1:303 APPLE HILL LN
Mailing Address - Street 2:
Mailing Address - City:STREAMWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60107-1058
Mailing Address - Country:US
Mailing Address - Phone:630-550-7420
Mailing Address - Fax:
Practice Address - Street 1:2663 N ELSTON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-2018
Practice Address - Country:US
Practice Address - Phone:773-394-7029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046011743152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist