Provider Demographics
NPI:1558410605
Name:SLONKE, ANNA MARIA (OD)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:MARIA
Last Name:SLONKE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:MARIA
Other - Last Name:LOCACCIATO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9621 N MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-1116
Mailing Address - Country:US
Mailing Address - Phone:847-965-3791
Mailing Address - Fax:847-965-3947
Practice Address - Street 1:9621 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-1116
Practice Address - Country:US
Practice Address - Phone:847-965-3791
Practice Address - Fax:847-965-3947
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-008228152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL579260007, 579250014Medicare PIN
ILL77741Medicare ID - Type Unspecified
ILU36652Medicare UPIN