Provider Demographics
NPI:1508053224
Name:HANNOUN, SELMA (OD)
Entity Type:Individual
Prefix:DR
First Name:SELMA
Middle Name:
Last Name:HANNOUN
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 1:81 BEACON ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02474-3304
Mailing Address - Country:US
Mailing Address - Phone:708-541-9978
Mailing Address - Fax:
Practice Address - Street 1:7050 S CICERO AVE
Practice Address - Street 2:
Practice Address - City:BEDFORD PARK
Practice Address - State:IL
Practice Address - Zip Code:60638-6402
Practice Address - Country:US
Practice Address - Phone:708-496-0680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-26
Last Update Date:2019-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1537152W00000X
MA5312152W00000X
IL046009734152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist