Provider Demographics
NPI:1932772944
Name:IDRISS, REMA (OD)
Entity Type:Individual
Prefix:
First Name:REMA
Middle Name:
Last Name:IDRISS
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 1:2005 S FINLEY RD UNIT 504
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-6490
Mailing Address - Country:US
Mailing Address - Phone:402-301-0726
Mailing Address - Fax:
Practice Address - Street 1:3340 MALL LOOP DR SPC 1532
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60431-1168
Practice Address - Country:US
Practice Address - Phone:815-436-1770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046011547207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology