Provider Demographics
NPI:1821151689
Name:ESTRIN-ROSSELSON, JULIA HASIA (OD)
Entity Type:Individual
Prefix:DR
First Name:JULIA
Middle Name:HASIA
Last Name:ESTRIN-ROSSELSON
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 1:23 LONGRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-7028
Mailing Address - Country:US
Mailing Address - Phone:847-919-5269
Mailing Address - Fax:847-255-8699
Practice Address - Street 1:1500 N ARLINGTON HEIGHTS RD
Practice Address - Street 2:1504
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-4827
Practice Address - Country:US
Practice Address - Phone:847-255-9922
Practice Address - Fax:847-255-8699
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
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
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL570770Medicare ID - Type Unspecified
ILU78910Medicare UPIN