Provider Demographics
NPI:1073796579
Name:WENDY SANDERS-MAUBACH,O.D., P.C.
Entity Type:Organization
Organization Name:WENDY SANDERS-MAUBACH,O.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDERS-MAUBACH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:815-433-1426
Mailing Address - Street 1:641 1ST ST
Mailing Address - Street 2:
Mailing Address - City:LA SALLE
Mailing Address - State:IL
Mailing Address - Zip Code:61301-2418
Mailing Address - Country:US
Mailing Address - Phone:815-223-0331
Mailing Address - Fax:815-223-6723
Practice Address - Street 1:107 E MCKINLEY RD
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:IL
Practice Address - Zip Code:61350
Practice Address - Country:US
Practice Address - Phone:815-433-1426
Practice Address - Fax:815-324-9417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-07
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL060-009493152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL216128Medicare PIN
IL5840450001Medicare NSC
IL687608Medicare UPIN