Provider Demographics
NPI:1376007229
Name:IANOVSKI, ANDREY (OD)
Entity Type:Individual
Prefix:
First Name:ANDREY
Middle Name:
Last Name:IANOVSKI
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 1:860 WEIDNER RD APT 502
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-4753
Mailing Address - Country:US
Mailing Address - Phone:440-212-6885
Mailing Address - Fax:
Practice Address - Street 1:8661 S HOWELL AVE STE 200
Practice Address - Street 2:
Practice Address - City:OAK CREEK
Practice Address - State:WI
Practice Address - Zip Code:53154-2919
Practice Address - Country:US
Practice Address - Phone:414-847-0164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-24
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI353735152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist