Provider Demographics
NPI:1033294871
Name:BUBANKO, STEVEN ANDREW (OD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:ANDREW
Last Name:BUBANKO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1230 N CEDAR RD UNIT A
Mailing Address - Street 2:
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-1272
Mailing Address - Country:US
Mailing Address - Phone:815-485-6533
Mailing Address - Fax:815-485-6534
Practice Address - Street 1:352 W. MAPLE ST.
Practice Address - Street 2:
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451
Practice Address - Country:US
Practice Address - Phone:815-485-6533
Practice Address - Fax:815-485-6534
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046009253152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046009253OtherLICENSE NUMBER
ILU84492Medicare UPIN