Provider Demographics
NPI:1316396179
Name:SZWAJCA, GABRIELLE MONICA (OD)
Entity Type:Individual
Prefix:DR
First Name:GABRIELLE
Middle Name:MONICA
Last Name:SZWAJCA
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 1:1906 S TURES LN
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60018-2012
Mailing Address - Country:US
Mailing Address - Phone:847-890-3172
Mailing Address - Fax:
Practice Address - Street 1:1906 S TURES LN
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60018-2012
Practice Address - Country:US
Practice Address - Phone:847-890-3172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-11
Last Update Date:2016-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046.010995152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist