Basic Information
| Provider Information | |||||||||
| NPI: | 1295080687 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANSARI | ||||||||
| FirstName: | SABRIYA | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1860 PAYSPHERE CIR | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606740018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6304699200 | ||||||||
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| Practice Location | |||||||||
| Address1: | 808 RICKERT DR STE 201 | ||||||||
| Address2: | |||||||||
| City: | NAPERVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605400910 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6303228300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2012 | ||||||||
| LastUpdateDate: | 11/17/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 0618002289 | VA | N | Eye and Vision Services Providers | Optometrist | 152W00000X | 4959 | MA | N | Eye and Vision Services Providers | Optometrist | 152W00000X | 046010598 | IL | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.