Provider Demographics
NPI:1467081919
Name:JAKUPOVIC, AMELA
Entity type:Individual
Prefix:
First Name:AMELA
Middle Name:
Last Name:JAKUPOVIC
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1346 PATRIOT BLVD
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-7777
Mailing Address - Country:US
Mailing Address - Phone:847-729-5050
Mailing Address - Fax:224-521-2995
Practice Address - Street 1:1346 PATRIOT BLVD
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-7777
Practice Address - Country:US
Practice Address - Phone:847-729-5050
Practice Address - Fax:224-521-2995
Is Sole Proprietor?:No
Enumeration Date:2020-04-06
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046011419152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist