Provider Demographics
NPI:1043335094
Name:OSTOICH, BRENT G (OD)
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:G
Last Name:OSTOICH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 PALATINE RD
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60195-1196
Mailing Address - Country:US
Mailing Address - Phone:847-776-8900
Mailing Address - Fax:847-776-8922
Practice Address - Street 1:1415 PALATINE RD
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60195-1196
Practice Address - Country:US
Practice Address - Phone:847-776-8900
Practice Address - Fax:847-776-8922
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046007960152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046007960Medicaid
ILIL2773OtherEYEMED PROVIDER NUMBER
ILK16833Medicare ID - Type UnspecifiedMEDICARE NUMBER