Provider Demographics
NPI:1760725923
Name:DZUBUR, HARIS (OD)
Entity Type:Individual
Prefix:
First Name:HARIS
Middle Name:
Last Name:DZUBUR
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 1:6201 W 95TH ST
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-3888
Mailing Address - Country:US
Mailing Address - Phone:708-636-9393
Mailing Address - Fax:708-636-2022
Practice Address - Street 1:6201 W 95TH ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-3888
Practice Address - Country:US
Practice Address - Phone:708-636-9393
Practice Address - Fax:708-636-2022
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-05
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046010766152WS0006X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision