Provider Demographics
NPI:1508681446
Name:MADANI, KHATIJA SYEDA (OD)
Entity type:Individual
Prefix:
First Name:KHATIJA
Middle Name:SYEDA
Last Name:MADANI
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 1:2010 S ARLINGTON HEIGHTS RD STE 121
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-4100
Mailing Address - Country:US
Mailing Address - Phone:847-621-0633
Mailing Address - Fax:847-621-0640
Practice Address - Street 1:2010 S ARLINGTON HEIGHTS RD STE 121
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-4100
Practice Address - Country:US
Practice Address - Phone:847-621-0633
Practice Address - Fax:847-621-0640
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-16
Last Update Date:2024-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046011936152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty