Provider Demographics
NPI:1265664502
Name:THOBANI, AZZRAH (OD, FAAO)
Entity Type:Individual
Prefix:
First Name:AZZRAH
Middle Name:
Last Name:THOBANI
Suffix:
Gender:F
Credentials:OD, FAAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1228 W MONROE ST UNIT 509
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-2581
Mailing Address - Country:US
Mailing Address - Phone:312-451-9496
Mailing Address - Fax:
Practice Address - Street 1:900 SKOKIE BLVD STE 150
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-4038
Practice Address - Country:US
Practice Address - Phone:847-497-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-20
Last Update Date:2021-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046.010256152W00000X
CT002806152W00000X
NYTUV007672152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist