Provider Demographics
NPI:1104793348
Name:LAFAZANOS, ELENI S (OD)
Entity type:Individual
Prefix:
First Name:ELENI
Middle Name:S
Last Name:LAFAZANOS
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 1:6759 TRIBAL CT
Mailing Address - Street 2:
Mailing Address - City:LONG GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60047-5119
Mailing Address - Country:US
Mailing Address - Phone:224-595-6455
Mailing Address - Fax:
Practice Address - Street 1:2453 N RICHMOND RD
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60051-5422
Practice Address - Country:US
Practice Address - Phone:815-528-1031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-22
Last Update Date:2025-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046012049152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist