Provider Demographics
NPI:1164597449
Name:SANTOYO, ALIA (OD)
Entity Type:Individual
Prefix:DR
First Name:ALIA
Middle Name:
Last Name:SANTOYO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:ALIA
Other - Middle Name:
Other - Last Name:SANTOYO-JOHNSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:3015 E NEW YORK ST STE A
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-5162
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1935 95TH ST UNIT 119
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-9685
Practice Address - Country:US
Practice Address - Phone:630-445-8166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL46009925152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046009925Medicaid
IL046009925Medicaid