Provider Demographics
NPI:1932413697
Name:TODD, ANN E (OD)
Entity Type:Individual
Prefix:DR
First Name:ANN
Middle Name:E
Last Name:TODD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:24733 S POTAWATOMIE TRL
Mailing Address - Street 2:
Mailing Address - City:CHANNAHON
Mailing Address - State:IL
Mailing Address - Zip Code:60410-8639
Mailing Address - Country:US
Mailing Address - Phone:815-238-1465
Mailing Address - Fax:
Practice Address - Street 1:1521 ESSINGTON ROAD
Practice Address - Street 2:EVERYTHING IN SIGHT
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435
Practice Address - Country:US
Practice Address - Phone:815-729-2002
Practice Address - Fax:815-436-8605
Is Sole Proprietor?:No
Enumeration Date:2010-08-04
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046010348152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL579270088Medicare PIN