Provider Demographics
NPI:1265628762
Name:AHMAD, SALEEM (OD)
Entity Type:Individual
Prefix:DR
First Name:SALEEM
Middle Name:
Last Name:AHMAD
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 1:6647 MAJESTIC WAY
Mailing Address - Street 2:
Mailing Address - City:CARPENTERSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60110-3438
Mailing Address - Country:US
Mailing Address - Phone:847-844-9860
Mailing Address - Fax:
Practice Address - Street 1:4234 S ARCHER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60632-2550
Practice Address - Country:US
Practice Address - Phone:773-254-6800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-18
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046.008543152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist