Provider Demographics
NPI:1295020113
Name:JEELANI, HUMA I (OD)
Entity Type:Individual
Prefix:DR
First Name:HUMA
Middle Name:I
Last Name:JEELANI
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 1:13400 S. RT. 59
Mailing Address - Street 2:SUITE 116-308
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60585
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 W RANDOLPH ST
Practice Address - Street 2:SUITE 104
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-3218
Practice Address - Country:US
Practice Address - Phone:312-263-4909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 4667152W00000X
TX9075152W00000X
IL046010495152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL999570Medicare PIN
IL0452870014Medicare NSC