Provider Demographics
NPI:1740273234
Name:CHAGLASIAN, ELYSE L (OD)
Entity type:Individual
Prefix:
First Name:ELYSE
Middle Name:L
Last Name:CHAGLASIAN
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 1:1585 BARRINGTON RD
Mailing Address - Street 2:SUITE 404
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-1090
Mailing Address - Country:US
Mailing Address - Phone:847-755-9393
Mailing Address - Fax:847-755-1560
Practice Address - Street 1:1585 BARRINGTON RD
Practice Address - Street 2:SUITE 404
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-1090
Practice Address - Country:US
Practice Address - Phone:847-755-9393
Practice Address - Fax:847-755-1560
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046008200152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL6046380001OtherNATIONAL GOVERNMENT SERVICES
IL046008200Medicaid
IL582060Medicare PIN
IL046008200Medicaid
ILL55550Medicare ID - Type Unspecified