Provider Demographics
NPI:1437609054
Name:DR. JERIES QTAMI & ASSOCIATES INC
Entity Type:Organization
Organization Name:DR. JERIES QTAMI & ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JERIES
Authorized Official - Middle Name:
Authorized Official - Last Name:QTAMI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:708-898-9112
Mailing Address - Street 1:47 W POLK ST STE 100-135
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-2000
Mailing Address - Country:US
Mailing Address - Phone:708-898-9112
Mailing Address - Fax:708-283-0609
Practice Address - Street 1:21000 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1900
Practice Address - Country:US
Practice Address - Phone:708-898-9112
Practice Address - Fax:708-283-0609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-06
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046010554152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046010554Medicaid