Provider Demographics
NPI:1780177469
Name:YAQUB, RABIA (OD)
Entity type:Individual
Prefix:
First Name:RABIA
Middle Name:
Last Name:YAQUB
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 1:757 LINDSEY LN
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-6171
Mailing Address - Country:US
Mailing Address - Phone:630-550-2851
Mailing Address - Fax:
Practice Address - Street 1:62 OAKBROOK CTR
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1810
Practice Address - Country:US
Practice Address - Phone:630-243-5224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-07
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046011085152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist