Provider Demographics
NPI:1356524888
Name:BURY, SANDRA L (OD)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:L
Last Name:BURY
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 1:6209 W 95TH ST
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2701
Mailing Address - Country:US
Mailing Address - Phone:708-423-2500
Mailing Address - Fax:
Practice Address - Street 1:6209 W 95TH ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2701
Practice Address - Country:US
Practice Address - Phone:708-423-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-06
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL04608858152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01621221OtherBC/BS
ILU58957Medicare UPIN
IL01621221OtherBC/BS
ILL62755Medicare PIN