Provider Demographics
NPI:1518936715
Name:PAWLAK, WILLIAM (O D)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:PAWLAK
Suffix:
Gender:M
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10905 SAWGRASS LN
Mailing Address - Street 2:
Mailing Address - City:HUNTLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60142-4048
Mailing Address - Country:US
Mailing Address - Phone:847-515-7882
Mailing Address - Fax:
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
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-009055152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
636170Medicare ID - Type Unspecified
ILU77478Medicare UPIN