Provider Demographics
NPI:1326153032
Name:PUSKAR, SANELA (OD)
Entity Type:Individual
Prefix:DR
First Name:SANELA
Middle Name:
Last Name:PUSKAR
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 1:2000 CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-2218
Mailing Address - Country:US
Mailing Address - Phone:847-864-0300
Mailing Address - Fax:847-864-0348
Practice Address - Street 1:2000 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-2218
Practice Address - Country:US
Practice Address - Phone:847-864-0300
Practice Address - Fax:847-864-0348
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-009721152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL7235044OtherAETNA
IL210209OtherMEDICARE GROUP
IL8825444OtherMULTIPLAN
IL1636706OtherBCBS
IL046009721Medicaid
IL8825444OtherMULTIPLAN
IL210209OtherMEDICARE GROUP
IL046009721Medicaid
IL7235044OtherAETNA
IL362492289OtherTIN
IL0757500001Medicare NSC