Provider Demographics
NPI:1235285321
Name:VALENTINO, FRANK MICHAEL (OD)
Entity Type:Individual
Prefix:MR
First Name:FRANK
Middle Name:MICHAEL
Last Name:VALENTINO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 N LARKIN AVE
Mailing Address - Street 2:
Mailing Address - City:CREST HILL
Mailing Address - State:IL
Mailing Address - Zip Code:60403
Mailing Address - Country:US
Mailing Address - Phone:815-741-1140
Mailing Address - Fax:815-941-8449
Practice Address - Street 1:1701 N LARKIN AVE
Practice Address - Street 2:
Practice Address - City:CREST HILL
Practice Address - State:IL
Practice Address - Zip Code:60435-1970
Practice Address - Country:US
Practice Address - Phone:815-741-1140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T36713Medicare UPIN