Provider Demographics
NPI:1083603518
Name:ANDREOLI, BARBARA J (OD)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:J
Last Name:ANDREOLI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:636 RAYMOND DR STE 300
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-9792
Mailing Address - Country:US
Mailing Address - Phone:331-732-4370
Mailing Address - Fax:331-732-4375
Practice Address - Street 1:636 RAYMOND DR STE 300
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-9792
Practice Address - Country:US
Practice Address - Phone:331-732-4370
Practice Address - Fax:331-732-4375
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-006802152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0534150002Medicare NSC
IL0534150001Medicare NSC
ILL94638Medicare PIN
ILT91784Medicare UPIN
IL0534150004Medicare NSC
IL0534150003Medicare NSC