Provider Demographics
NPI:1912061557
Name:MACQUEEN, CONSTANCE SUE (OD)
Entity Type:Individual
Prefix:DR
First Name:CONSTANCE
Middle Name:SUE
Last Name:MACQUEEN
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 1:7117 W ARCHER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60638-2203
Mailing Address - Country:US
Mailing Address - Phone:773-586-8444
Mailing Address - Fax:773-586-8448
Practice Address - Street 1:7117 W ARCHER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60638-2203
Practice Address - Country:US
Practice Address - Phone:773-586-8444
Practice Address - Fax:773-586-8448
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
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
ILL72353Medicare ID - Type Unspecified
ILT38949Medicare UPIN