Provider Demographics
NPI:1588637300
Name:SIAVELIS, ANDRIANI (OD)
Entity Type:Individual
Prefix:DR
First Name:ANDRIANI
Middle Name:
Last Name:SIAVELIS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:489 MITCHELL AVE
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-3903
Mailing Address - Country:US
Mailing Address - Phone:630-279-0503
Mailing Address - Fax:708-531-1078
Practice Address - Street 1:10439 W CERMAK RD
Practice Address - Street 2:
Practice Address - City:WESTCHESTER
Practice Address - State:IL
Practice Address - Zip Code:60154-5237
Practice Address - Country:US
Practice Address - Phone:708-531-1031
Practice Address - Fax:708-531-1078
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL366000Medicare ID - Type Unspecified
ILG89315Medicare UPIN