Provider Demographics
NPI:1346238664
Name:SANDERS-MAUBACH, WENDY (OD)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:
Last Name:SANDERS-MAUBACH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:SANDERS
Other - Last Name:BRISKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:107 E MCKINLEY RD
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:IL
Mailing Address - Zip Code:61350-4801
Mailing Address - Country:US
Mailing Address - Phone:815-433-1426
Mailing Address - Fax:815-324-9417
Practice Address - Street 1:107 E MCKINLEY RD
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:IL
Practice Address - Zip Code:61350-4801
Practice Address - Country:US
Practice Address - Phone:815-433-1426
Practice Address - Fax:815-324-9417
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2017-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046.009512152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK49083Medicare PIN
AZU87608Medicare UPIN