Provider Demographics
NPI:1679712483
Name:ADENWALLA, ZAHRA (OD)
Entity Type:Individual
Prefix:DR
First Name:ZAHRA
Middle Name:
Last Name:ADENWALLA
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 1:3125 S ASHLAND AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-6231
Mailing Address - Country:US
Mailing Address - Phone:773-890-1100
Mailing Address - Fax:
Practice Address - Street 1:3125 S ASHLAND AVE STE 204
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-6231
Practice Address - Country:US
Practice Address - Phone:773-890-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-18
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046.010178152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist