Provider Demographics
NPI:1144517020
Name:BHAMBRI, AMIT (OD)
Entity type:Individual
Prefix:MR
First Name:AMIT
Middle Name:
Last Name:BHAMBRI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 CHARLELA LN
Mailing Address - Street 2:APT 202
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-7249
Mailing Address - Country:US
Mailing Address - Phone:773-354-0239
Mailing Address - Fax:
Practice Address - Street 1:1601 N HARLEM AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60707-4303
Practice Address - Country:US
Practice Address - Phone:773-836-4110
Practice Address - Fax:773-637-1109
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-29
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046010438152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist