Provider Demographics
NPI:1356423818
Name:VANNATTA, SHAILJA (OD)
Entity type:Individual
Prefix:DR
First Name:SHAILJA
Middle Name:
Last Name:VANNATTA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:SHAILJA
Other - Middle Name:
Other - Last Name:TOOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:2663-2661 N. ELSTON AVE
Mailing Address - Street 2:RIVERFRONT PLAZA-AMERICA'S BEST CONTACTS AND EYEGLASSES
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647
Mailing Address - Country:US
Mailing Address - Phone:773-394-7029
Mailing Address - Fax:773-394-7040
Practice Address - Street 1:1320 S ROUTE 59
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-5944
Practice Address - Country:US
Practice Address - Phone:630-328-2906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-009793152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist