Provider Demographics
NPI:1831548288
Name:JAWDI, HENNA (OD)
Entity type:Individual
Prefix:DR
First Name:HENNA
Middle Name:
Last Name:JAWDI
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 1:16420 SHAWNEE DR
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:IL
Mailing Address - Zip Code:60441-4391
Mailing Address - Country:US
Mailing Address - Phone:708-691-3992
Mailing Address - Fax:
Practice Address - Street 1:9265 159TH ST
Practice Address - Street 2:
Practice Address - City:ORLAND HILLS
Practice Address - State:IL
Practice Address - Zip Code:60487-5977
Practice Address - Country:US
Practice Address - Phone:708-349-4360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046010987152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist