Provider Demographics
NPI:1437414398
Name:CUROSH, LAUREN JO (OD)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:JO
Last Name:CUROSH
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 1:2146 N HALSTED ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-4397
Mailing Address - Country:US
Mailing Address - Phone:773-975-7867
Mailing Address - Fax:773-404-1725
Practice Address - Street 1:2146 N HALSTED ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-4397
Practice Address - Country:US
Practice Address - Phone:773-975-7867
Practice Address - Fax:773-404-1725
Is Sole Proprietor?:No
Enumeration Date:2012-07-06
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003735A152W00000X
IL046010625152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL7235044OtherAETNA
IL210209OtherMEDICARE COOK COUNTY
IL8825444OtherMULTIPLAN
1636706OtherBCBS
IL211019OtherMEDICARE LAKE/DUPAGE COUNTY