Provider Demographics
NPI:1326095563
Name:WILLIAM E. PAWLAK P C
Entity Type:Organization
Organization Name:WILLIAM E. PAWLAK P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:PAWLAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-650-3375
Mailing Address - Street 1:2101 GATEWAY CENTER DR
Mailing Address - Street 2:
Mailing Address - City:BELVIDERE
Mailing Address - State:IL
Mailing Address - Zip Code:61008-9310
Mailing Address - Country:US
Mailing Address - Phone:815-547-5950
Mailing Address - Fax:815-547-7057
Practice Address - Street 1:2101 GATEWAY CENTER DR
Practice Address - Street 2:
Practice Address - City:BELVIDERE
Practice Address - State:IL
Practice Address - Zip Code:61008-9310
Practice Address - Country:US
Practice Address - Phone:815-547-5950
Practice Address - Fax:815-547-7057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-30
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046009055152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046009055Medicaid
ILK27817OtherRENDERING PROVIDER NUMBER
IL213608Medicare ID - Type Unspecified
IL046009055Medicaid