Provider Demographics
NPI:1093851487
Name:DRS. LEAHY & DISALVO-OST, P.C.
Entity Type:Organization
Organization Name:DRS. LEAHY & DISALVO-OST, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:E
Authorized Official - Last Name:PAWELSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-425-6500
Mailing Address - Street 1:4445 W 95TH ST
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-7219
Mailing Address - Country:US
Mailing Address - Phone:708-425-6500
Mailing Address - Fax:708-425-1455
Practice Address - Street 1:4445 W 95TH ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-7219
Practice Address - Country:US
Practice Address - Phone:708-425-6500
Practice Address - Fax:708-425-1455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL060.003768152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILCN3870OtherRR MEDICARE
ILCN3870OtherRR MEDICARE
IL0618250001Medicare NSC
ILT365669Medicare UPIN