Provider Demographics
NPI:1568801710
Name:DIDIER, JAMI HAGER (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMI
Middle Name:HAGER
Last Name:DIDIER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:JAMI
Other - Middle Name:
Other - Last Name:HAGER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:480 W BOUGHTON RD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-1890
Mailing Address - Country:US
Mailing Address - Phone:630-759-6506
Mailing Address - Fax:630-759-6651
Practice Address - Street 1:480 W BOUGHTON RD
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-1890
Practice Address - Country:US
Practice Address - Phone:630-759-6506
Practice Address - Fax:630-759-6651
Is Sole Proprietor?:No
Enumeration Date:2013-06-20
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046010686152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400111943Medicare PIN