Provider Demographics
NPI:1225284979
Name:MCCARTHY, MIRJANA DORDEVIC (OD)
Entity Type:Individual
Prefix:DR
First Name:MIRJANA
Middle Name:DORDEVIC
Last Name:MCCARTHY
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 1:225 PARK AVENUE
Mailing Address - Street 2:
Mailing Address - City:CLARENDON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60514-1301
Mailing Address - Country:US
Mailing Address - Phone:630-323-3202
Mailing Address - Fax:630-321-0512
Practice Address - Street 1:225 PARK AVENUE
Practice Address - Street 2:
Practice Address - City:CLARENDON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60514-1301
Practice Address - Country:US
Practice Address - Phone:630-323-3202
Practice Address - Fax:630-321-0512
Is Sole Proprietor?:No
Enumeration Date:2008-08-13
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046.010151152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046010151Medicaid
ILR02873Medicare PIN