Provider Demographics
NPI:1205317146
Name:SIDHU, RANJODH SINGH (OD)
Entity type:Individual
Prefix:DR
First Name:RANJODH
Middle Name:SINGH
Last Name:SIDHU
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 1:1344 N ROSEBUD LN
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:IL
Mailing Address - Zip Code:60101-5729
Mailing Address - Country:US
Mailing Address - Phone:630-744-9607
Mailing Address - Fax:
Practice Address - Street 1:851 W ARMITAGE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-4328
Practice Address - Country:US
Practice Address - Phone:773-341-1890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046.011229152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist