Provider Demographics
NPI:1003975913
Name:PICA, MARIA (OD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:
Last Name:PICA
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 1:40W330 LAFOX ROAD
Mailing Address - Street 2:
Mailing Address - City:ST. CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60175
Mailing Address - Country:US
Mailing Address - Phone:630-584-9850
Mailing Address - Fax:630-584-1523
Practice Address - Street 1:40W330 LAFOX ROAD
Practice Address - Street 2:
Practice Address - City:ST. CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60175
Practice Address - Country:US
Practice Address - Phone:630-584-9850
Practice Address - Fax:630-584-1523
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL46008764Medicaid
IL4519570OtherBCBS
ILU63133Medicare UPIN
ILK12615Medicare ID - Type Unspecified
IL0151380001Medicare NSC