Provider Demographics
NPI:1033417845
Name:DONALD V MADUZIA OD PC
Entity Type:Organization
Organization Name:DONALD V MADUZIA OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:V
Authorized Official - Last Name:MADUZIA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:630-323-3202
Mailing Address - Street 1:203 RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:CLARENDON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60514-1301
Mailing Address - Country:US
Mailing Address - Phone:630-323-3202
Mailing Address - Fax:630-321-0512
Practice Address - Street 1:203 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:CLARENDON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60514-1301
Practice Address - Country:US
Practice Address - Phone:630-323-3202
Practice Address - Fax:630-321-0512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-02
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-007789152W00000X
IL046.007789332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty