Provider Demographics
NPI:1891885695
Name:KAPOOR, BHANU (OD)
Entity Type:Individual
Prefix:DR
First Name:BHANU
Middle Name:
Last Name:KAPOOR
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 1:7000 MANNHEIM RD
Mailing Address - Street 2:
Mailing Address - City:ROSEMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60018-3621
Mailing Address - Country:US
Mailing Address - Phone:847-795-1807
Mailing Address - Fax:847-795-0141
Practice Address - Street 1:7000 MANNHEIM RD
Practice Address - Street 2:
Practice Address - City:ROSEMONT
Practice Address - State:IL
Practice Address - Zip Code:60018-3621
Practice Address - Country:US
Practice Address - Phone:847-795-1807
Practice Address - Fax:847-795-0141
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL7520397OtherAETNA PROVIDER NUMBER
IL1635275OtherBLUE CROSS BLUE SHIELD
IL1635275OtherBLUE CROSS BLUE SHIELD