Provider Demographics
NPI:1598071227
Name:STEVEN A. UDESKY, O.D. & ASSOCIATES L.L.C.
Entity Type:Organization
Organization Name:STEVEN A. UDESKY, O.D. & ASSOCIATES L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:UDESKY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:847-562-2010
Mailing Address - Street 1:2750 DUNDEE RD STE 2
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-2600
Mailing Address - Country:US
Mailing Address - Phone:847-562-2010
Mailing Address - Fax:847-562-2012
Practice Address - Street 1:2750 DUNDEE RD STE 2
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-2600
Practice Address - Country:US
Practice Address - Phone:847-562-2010
Practice Address - Fax:847-562-2012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-18
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046009031152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========OtherEIN