Provider Demographics
NPI:1649375031
Name:PERVEZ RASUL M.D.,,S.C.
Entity type:Organization
Organization Name:PERVEZ RASUL M.D.,,S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PERVEZ
Authorized Official - Middle Name:
Authorized Official - Last Name:RASUL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-484-4488
Mailing Address - Street 1:2215 OAK PARK AVE
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-2220
Mailing Address - Country:US
Mailing Address - Phone:708-484-4488
Mailing Address - Fax:708-484-4533
Practice Address - Street 1:2215 OAK PARK AVE
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-2220
Practice Address - Country:US
Practice Address - Phone:708-484-4488
Practice Address - Fax:708-484-4533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC42038Medicare UPIN
IL214059Medicare ID - Type Unspecified