Provider Demographics
NPI:1134472996
Name:MARZEC, PAMELA MARIE (OD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:MARIE
Last Name:MARZEC
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 1:4024 CONIFER DR
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60124-3146
Mailing Address - Country:US
Mailing Address - Phone:847-242-1692
Mailing Address - Fax:847-330-2236
Practice Address - Street 1:999 N PLAZA DR STE 100
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-5403
Practice Address - Country:US
Practice Address - Phone:847-413-2110
Practice Address - Fax:847-413-2114
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-17
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3688-35152W00000X
PAOEG0033974152W00000X
IA105503152W00000X
FLTPOP22152W00000X
VA0618002850152W00000X
NJ27OA00704300152W00000X
NYTUV009099152W00000X, 152W00000X
IL046010627152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL8869001Medicare UPIN