Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 046009750 | IL |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 046009750 | IL |
N | 152WL0500X | Optomitrist - Low Vision Rehabilitation | 046009750 | IL |
N | 152WP0200X | Pediatric Optomitrist | 046009750 | IL |
NPI | 1124068572 |
---|---|
Provider Name | Dr. Deana R Labrosse |
First Address | Evanston, IL 60202-1949 |
Second Address | Evanston, IL 60202-1816 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2006 |
Last Update Date | 30/11/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
046009750 | (05) | IL |
V06497 | (02) | IL |