1598864324 NPI number — DR ATHA HYDERI PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598864324 NPI number — DR ATHA HYDERI PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR ATHA HYDERI PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PRIMARY VISION CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598864324
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
833 N ROSELLE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROSELLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60172-4212
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-351-0085
Provider Business Mailing Address Fax Number:
630-351-1530

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
833 N ROSELLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROSELLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60172-4212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-351-0085
Provider Business Practice Location Address Fax Number:
630-351-1530
Provider Enumeration Date:
09/21/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HYDERI
Authorized Official First Name:
ATHA
Authorized Official Middle Name:
ALI
Authorized Official Title or Position:
OPTOMETRIST
Authorized Official Telephone Number:
630-351-0085

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 152WC0802X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WL0500X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WP0200X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WS0006X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WV0400X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WX0102X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)