Provider Demographics
NPI:1295080687
Name:ANSARI, SABRIYA (OD)
Entity type:Individual
Prefix:
First Name:SABRIYA
Middle Name:
Last Name:ANSARI
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 1:1860 PAYSPHERE CIR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-0018
Mailing Address - Country:US
Mailing Address - Phone:630-469-9200
Mailing Address - Fax:
Practice Address - Street 1:808 RICKERT DR STE 201
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-0910
Practice Address - Country:US
Practice Address - Phone:630-322-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-21
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618002289152W00000X
MA4959152W00000X
IL046010598152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist