Provider Demographics
NPI:1629749932
Name:AUGUSTINE, ALIN (OD)
Entity Type:Individual
Prefix:
First Name:ALIN
Middle Name:
Last Name:AUGUSTINE
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 1:83 TEMPLETON DR STE F
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-7025
Mailing Address - Country:US
Mailing Address - Phone:630-554-8002
Mailing Address - Fax:630-554-8095
Practice Address - Street 1:83 TEMPLETON DR STE F
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:IL
Practice Address - Zip Code:60543-7025
Practice Address - Country:US
Practice Address - Phone:630-554-8002
Practice Address - Fax:630-554-8095
Is Sole Proprietor?:No
Enumeration Date:2021-09-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046011695152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist