Provider Demographics
NPI:1356310841
Name:FOREMAN, PAUL A (OD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:A
Last Name:FOREMAN
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 1:6601 N AVONDALE AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-1572
Mailing Address - Country:US
Mailing Address - Phone:773-792-1011
Mailing Address - Fax:773-889-0224
Practice Address - Street 1:6601 N AVONDALE AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-1572
Practice Address - Country:US
Practice Address - Phone:773-792-1011
Practice Address - Fax:773-889-0224
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1622243OtherBCBS IL GROUP
ILP00210275Medicare PIN
ILK15971Medicare PIN
IL1622243OtherBCBS IL GROUP