Provider Demographics
NPI:1164617197
Name:MAJEWSKI, AGATA E (OD)
Entity Type:Individual
Prefix:
First Name:AGATA
Middle Name:E
Last Name:MAJEWSKI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:833 W BUENA AVE
Mailing Address - Street 2:#2206
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-6600
Mailing Address - Country:US
Mailing Address - Phone:812-219-6438
Mailing Address - Fax:
Practice Address - Street 1:4214 N HARLEM AVE
Practice Address - Street 2:HARLEM-IRVING PLAZA SHOPPING CENTER
Practice Address - City:NORRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60706-1204
Practice Address - Country:US
Practice Address - Phone:708-453-6644
Practice Address - Fax:708-452-9532
Is Sole Proprietor?:No
Enumeration Date:2007-09-12
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist