Provider Demographics
NPI:1992363360
Name:JEEVAN, SWEATHA (OD)
Entity Type:Individual
Prefix:MS
First Name:SWEATHA
Middle Name:
Last Name:JEEVAN
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 1:1100 W CENTRAL RD STE 205
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-2465
Mailing Address - Country:US
Mailing Address - Phone:847-253-4040
Mailing Address - Fax:847-253-3028
Practice Address - Street 1:1100 W CENTRAL RD STE 205
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-2465
Practice Address - Country:US
Practice Address - Phone:847-253-4040
Practice Address - Fax:847-253-3028
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-31
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046011287152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist