Provider Demographics
NPI:1518049626
Name:MADUZIA, DONALD (OD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:MADUZIA
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 1:203 RAILROAD DRIVE
Mailing Address - Street 2:DONALD MADUZIA OD
Mailing Address - City:CLARENDON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60514
Mailing Address - Country:US
Mailing Address - Phone:630-323-3202
Mailing Address - Fax:630-321-0512
Practice Address - Street 1:203 RAILROAD DRIVE
Practice Address - Street 2:DONALD MADUZIA OD
Practice Address - City:CLARENDON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60514
Practice Address - Country:US
Practice Address - Phone:630-323-3202
Practice Address - Fax:630-321-0512
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046007789152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1700052834OtherMEDICARE DURABLE GOODS
IL2284078OtherBCBS
IL2284078OtherBCBS
T38963Medicare UPIN