Provider Demographics
NPI:1306829601
Name:DELEE, DENNIS (OD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:
Last Name:DELEE
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 1:209 S LASALLE ST
Mailing Address - Street 2:STE. 120
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60604-1219
Mailing Address - Country:US
Mailing Address - Phone:312-332-4461
Mailing Address - Fax:312-332-4461
Practice Address - Street 1:209 S LASALLE ST
Practice Address - Street 2:STE. 120
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60604-1219
Practice Address - Country:US
Practice Address - Phone:312-332-4461
Practice Address - Fax:312-332-4461
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-22
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL46-006526152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL118137OtherEYE MED VISION
IL3123324461OtherVISION SERVICE PLAN ID
ILU20886Medicare UPIN
ILL81918Medicare PIN