Provider Demographics
NPI:1265634810
Name:HUSSAIN, KAMRAN (OD)
Entity Type:Individual
Prefix:DR
First Name:KAMRAN
Middle Name:
Last Name:HUSSAIN
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 1:3429 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-1061
Mailing Address - Country:US
Mailing Address - Phone:847-452-5811
Mailing Address - Fax:
Practice Address - Street 1:635 CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-2365
Practice Address - Country:US
Practice Address - Phone:847-901-0781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046009594152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist