Provider Demographics
NPI:1619214301
Name:MCCARTAN, MARYJO (OD)
Entity Type:Individual
Prefix:DR
First Name:MARYJO
Middle Name:
Last Name:MCCARTAN
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 1:2600 N SOUTHPORT AVE
Mailing Address - Street 2:#209
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-1134
Mailing Address - Country:US
Mailing Address - Phone:773-590-4740
Mailing Address - Fax:708-403-6602
Practice Address - Street 1:24 ORLAND SQUARE DR
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-3207
Practice Address - Country:US
Practice Address - Phone:708-403-3555
Practice Address - Fax:708-403-6602
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-15
Last Update Date:2024-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046008779152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist