Provider Demographics
NPI:1083741979
Name:SERPICO, ANTHONY A (OD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:A
Last Name:SERPICO
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 1:6 E PHILLIP RD STE 1110
Mailing Address - Street 2:
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-1700
Mailing Address - Country:US
Mailing Address - Phone:847-816-9996
Mailing Address - Fax:847-816-3142
Practice Address - Street 1:6 E PHILLIP RD STE 1110
Practice Address - Street 2:
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061
Practice Address - Country:US
Practice Address - Phone:847-816-9996
Practice Address - Fax:847-816-3142
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046009099152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04915265OtherBLUE CROSS - BLUE SHIELD
IL046009099Medicaid
U73435Medicare UPIN
IL530030Medicare PIN