Provider Demographics
NPI:1588799852
Name:SILVESTRE, MARY ELAINE HERNANDEZ (OD)
Entity Type:Individual
Prefix:
First Name:MARY ELAINE
Middle Name:HERNANDEZ
Last Name:SILVESTRE
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 1:6023 W BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-5116
Mailing Address - Country:US
Mailing Address - Phone:847-701-5252
Mailing Address - Fax:847-966-0578
Practice Address - Street 1:6023 W. BELMONT AVE.
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-5116
Practice Address - Country:US
Practice Address - Phone:773-237-4332
Practice Address - Fax:773-237-5779
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-009931152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist