Provider Demographics
NPI:1811051667
Name:UBHI, SUKHDEEP S (OD)
Entity type:Individual
Prefix:
First Name:SUKHDEEP
Middle Name:S
Last Name:UBHI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:549 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-2565
Mailing Address - Country:US
Mailing Address - Phone:630-993-1632
Mailing Address - Fax:773-918-1628
Practice Address - Street 1:6153 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60636-2047
Practice Address - Country:US
Practice Address - Phone:773-918-4367
Practice Address - Fax:773-918-1628
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-009484152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL157019Medicare UPIN