Provider Demographics
NPI:1912314477
Name:HINDMAN, AVALON VICTORIA (OD)
Entity Type:Individual
Prefix:
First Name:AVALON
Middle Name:VICTORIA
Last Name:HINDMAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:AVALON
Other - Middle Name:VICTORIA
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:3125 S ASHLAND AVE
Mailing Address - Street 2:SUITE 240
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-6252
Mailing Address - Country:US
Mailing Address - Phone:773-890-1100
Mailing Address - Fax:773-890-1580
Practice Address - Street 1:3125 S ASHLAND AVE
Practice Address - Street 2:SUITE 240
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-6252
Practice Address - Country:US
Practice Address - Phone:773-890-1100
Practice Address - Fax:773-890-1580
Is Sole Proprietor?:No
Enumeration Date:2014-07-16
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046.010771152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400163235Medicare UPIN