Provider Demographics
NPI:1891893913
Name:CHAWLA, NEETU (OD)
Entity Type:Individual
Prefix:
First Name:NEETU
Middle Name:
Last Name:CHAWLA
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 1:1326 ALEXANDER DR
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60490-4947
Mailing Address - Country:US
Mailing Address - Phone:215-432-7729
Mailing Address - Fax:
Practice Address - Street 1:12690 S ROUTE 59
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60585-5412
Practice Address - Country:US
Practice Address - Phone:815-267-3060
Practice Address - Fax:815-267-3062
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-009687152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist