Provider Demographics
NPI:1306045083
Name:ALLEN, MEGAN SUZANNE (OD)
Entity Type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:SUZANNE
Last Name:ALLEN
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 1:3241 S MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-3849
Mailing Address - Country:US
Mailing Address - Phone:312-225-6200
Mailing Address - Fax:312-949-7660
Practice Address - Street 1:3241 S MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-3849
Practice Address - Country:US
Practice Address - Phone:312-225-6200
Practice Address - Fax:312-949-7660
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046009951152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046009951Medicaid
IL1083684922OtherNPI GROUP THE EYE SPECIALIST CENTER
IL047935428Medicaid
IL047935429OtherOPTOMETRIST LIC. FOR ORLAND PARK LOCATION ESC
IL047935429Medicaid
IL207W00000XOtherOPHTHALMOLOGY TAXONOMY
IL047935428OtherOPTOMETRIST LIC. FOR CHICAGO RIDGE LOCATION ESC
IL1699802421OtherOPTICAL NPI THE EYE SPECIALIST CENTER
IL205785OtherPTAN IL MEDICARE COOK COUNTY
IL047935428Medicaid
IL6180260001Medicare NSC