Provider Demographics
NPI:1053319772
Name:ANTMAN, ALBERTO
Entity Type:Individual
Prefix:MR
First Name:ALBERTO
Middle Name:
Last Name:ANTMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 SKOKIE BLVD
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-3050
Mailing Address - Country:US
Mailing Address - Phone:847-251-3330
Mailing Address - Fax:847-251-9580
Practice Address - Street 1:120 SKOKIE BLVD
Practice Address - Street 2:
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-3050
Practice Address - Country:US
Practice Address - Phone:847-251-3330
Practice Address - Fax:847-251-9580
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0743140001Medicare ID - Type Unspecified