Provider Demographics
NPI:1619330263
Name:SULAKHE, AMEERA (OD)
Entity type:Individual
Prefix:DR
First Name:AMEERA
Middle Name:
Last Name:SULAKHE
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 1:9241 MENARD AVE
Mailing Address - Street 2:
Mailing Address - City:MORTON GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60053-1563
Mailing Address - Country:US
Mailing Address - Phone:909-964-3661
Mailing Address - Fax:
Practice Address - Street 1:5315 W DEVON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-4102
Practice Address - Country:US
Practice Address - Phone:773-775-6555
Practice Address - Fax:773-775-3350
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-31
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33358152W00000X
IL046.011259152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist