Provider Demographics
NPI:1619040888
Name:GIANFRIDDO, MICHELLE C (OD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:C
Last Name:GIANFRIDDO
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 1:2015 MCDANIEL AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-2124
Mailing Address - Country:US
Mailing Address - Phone:847-869-2074
Mailing Address - Fax:
Practice Address - Street 1:503 HAWTHORNE SHOPPING CENTER
Practice Address - Street 2:
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-2680
Practice Address - Country:US
Practice Address - Phone:847-816-1188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL46008198152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU33678Medicare UPIN