Provider Demographics
NPI:1700814530
Name:COMBS, IRENE D (OD)
Entity Type:Individual
Prefix:DR
First Name:IRENE
Middle Name:D
Last Name:COMBS
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 1:504 HILLGROVE AVE
Mailing Address - Street 2:
Mailing Address - City:WESTERN SPRINGS
Mailing Address - State:IL
Mailing Address - Zip Code:60558-1481
Mailing Address - Country:US
Mailing Address - Phone:708-286-1100
Mailing Address - Fax:708-286-1103
Practice Address - Street 1:504 HILLGROVE AVE
Practice Address - Street 2:
Practice Address - City:WESTERN SPRINGS
Practice Address - State:IL
Practice Address - Zip Code:60558-1481
Practice Address - Country:US
Practice Address - Phone:708-286-1100
Practice Address - Fax:708-286-1103
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2008-03-26
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
IL01635462OtherBC/BS
IL204981Medicare ID - Type Unspecified
ILU56040Medicare UPIN