Provider Demographics
NPI:1437323896
Name:VASAIWALA, ROSHNI A (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSHNI
Middle Name:A
Last Name:VASAIWALA
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:4684 DEPT
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60122-4684
Mailing Address - Country:US
Mailing Address - Phone:708-952-0109
Mailing Address - Fax:708-952-0329
Practice Address - Street 1:DEPT. 4684
Practice Address - Street 2:
Practice Address - City:CAROL STREAM
Practice Address - State:IL
Practice Address - Zip Code:60122-4684
Practice Address - Country:US
Practice Address - Phone:708-952-0109
Practice Address - Fax:708-952-0329
Is Sole Proprietor?:No
Enumeration Date:2008-04-16
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036128553207WX0120X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0120XAllopathic & Osteopathic PhysiciansOphthalmologyCornea and External Diseases Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036128553Medicaid
IL1083684922OtherGROUP NPI
IL205786OtherPTAN IL MEDICARE DUPAGE COUNTY
IL12324832OtherCAQH
IL1699802421OtherOPTICAL NPI THE EYE SPECIALISTS CENTER
IL60180260001OtherDEMERC SUPPLIER PTAN
IL01620861OtherBLUE CROSS BLUE SHEILD GRP ID NUMBER
IL205785OtherPTAN IL MEDICARE COOK COUNTY
ILCK7818OtherMEDICARE RAILROAD GRP PTAN
IL036128553OtherPHYSICIAN LICENSE
IL12324832OtherCAQH