Provider Demographics
NPI:1942500798
Name:HUSSAIN, MAHJABEEN S (O D)
Entity Type:Individual
Prefix:
First Name:MAHJABEEN
Middle Name:S
Last Name:HUSSAIN
Suffix:
Gender:F
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 E 22ND ST
Mailing Address - Street 2:SUITE 212
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-4977
Mailing Address - Country:US
Mailing Address - Phone:630-495-8633
Mailing Address - Fax:630-495-8643
Practice Address - Street 1:10 E 22ND ST
Practice Address - Street 2:SUITE 212
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-4977
Practice Address - Country:US
Practice Address - Phone:630-495-8633
Practice Address - Fax:630-495-8643
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-27
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046008593152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist