Provider Demographics
NPI:1437281920
Name:VARGHESE, SHINU PHILIP (OD)
Entity Type:Individual
Prefix:
First Name:SHINU
Middle Name:PHILIP
Last Name:VARGHESE
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 1:7516 CASS AVE STE 12
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:IL
Mailing Address - Zip Code:60561-4588
Mailing Address - Country:US
Mailing Address - Phone:630-968-9440
Mailing Address - Fax:
Practice Address - Street 1:7516 S CASS AVE
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:IL
Practice Address - Zip Code:60561-4496
Practice Address - Country:US
Practice Address - Phone:630-968-9440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-10
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046009754152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046009754OtherSTATE LICENSE