Provider Demographics
NPI:1831248939
Name:CHANDRASEKAR, RADHIKA (OD)
Entity type:Individual
Prefix:
First Name:RADHIKA
Middle Name:
Last Name:CHANDRASEKAR
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:RADHIKA
Other - Middle Name:
Other - Last Name:SAJJA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:505 N LAKE SHORE DR
Mailing Address - Street 2:APT #1907
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3427
Mailing Address - Country:US
Mailing Address - Phone:312-923-9343
Mailing Address - Fax:
Practice Address - Street 1:205 N MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-5927
Practice Address - Country:US
Practice Address - Phone:312-819-0205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-009183152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU77919Medicare UPIN
ILL77739Medicare PIN