Basic Information
| Provider Information | |||||||||
| NPI: | 1912963182 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ZEID | ||||||||
| FirstName: | JANICE | ||||||||
| MiddleName: | LASKY | ||||||||
| NamePrefix: | |||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | LASKY | ||||||||
| OtherFirstName: | JANICE | ||||||||
| OtherMiddleName: | B | ||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 35422 EAGLE WAY | ||||||||
| Address2: | BOX 70 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606781354 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7738804000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2300 N CHILDRENS PLZ | ||||||||
| Address2: | BOX 70 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606143363 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7738804000 | ||||||||
| FaxNumber: | 7738803025 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2006 | ||||||||
| LastUpdateDate: | 11/05/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | IL | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 1627123 | 01 | IL | BCBS | OTHER |