Provider Demographics
NPI:1144275082
Name:AKBAR, SABAH (OD)
Entity type:Individual
Prefix:DR
First Name:SABAH
Middle Name:
Last Name:AKBAR
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 1:522 64TH ST
Mailing Address - Street 2:
Mailing Address - City:WILLOWBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527-1813
Mailing Address - Country:US
Mailing Address - Phone:630-667-6926
Mailing Address - Fax:
Practice Address - Street 1:3340 MALL LOOP DR
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60431-1057
Practice Address - Country:US
Practice Address - Phone:815-439-1400
Practice Address - Fax:815-435-1435
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-22
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046009559152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU97404Medicare UPIN