Provider Demographics
NPI:1891775144
Name:DENENBERG, IRVE (OD)
Entity Type:Individual
Prefix:
First Name:IRVE
Middle Name:
Last Name:DENENBERG
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 1:2074 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-6301
Mailing Address - Country:US
Mailing Address - Phone:847-688-5575
Mailing Address - Fax:
Practice Address - Street 1:1020 11TH AVE
Practice Address - Street 2:
Practice Address - City:GREAT LAKES
Practice Address - State:IL
Practice Address - Zip Code:60088-3102
Practice Address - Country:US
Practice Address - Phone:847-688-7757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-20
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2794152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision