Provider Demographics
NPI:1295893808
Name:RAMACHANDRAN, PRASOD C (OD)
Entity type:Individual
Prefix:
First Name:PRASOD
Middle Name:C
Last Name:RAMACHANDRAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:NARAYANAN
Other - Middle Name:C
Other - Last Name:RAMACHANDRAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:3624 W 26TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60623
Mailing Address - Country:US
Mailing Address - Phone:773-762-5662
Mailing Address - Fax:773-762-0721
Practice Address - Street 1:3624 W 26TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60623
Practice Address - Country:US
Practice Address - Phone:773-762-5662
Practice Address - Fax:773-762-0721
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046008787152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046008787Medicaid
U82301Medicare UPIN
IL046008787Medicaid