Provider Demographics
NPI:1609914332
Name:DHALIWAL, AMANDEEP (OD)
Entity Type:Individual
Prefix:
First Name:AMANDEEP
Middle Name:
Last Name:DHALIWAL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1845 S MICHIGAN AVE
Mailing Address - Street 2:APT #1803
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-2376
Mailing Address - Country:US
Mailing Address - Phone:630-345-0787
Mailing Address - Fax:
Practice Address - Street 1:9531 S CICERO AVE
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-3136
Practice Address - Country:US
Practice Address - Phone:708-423-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist