Provider Demographics
NPI:1629028444
Name:VANLENTE, ROBERT (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:VANLENTE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10001 W 143RD ST
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-2026
Mailing Address - Country:US
Mailing Address - Phone:708-349-2600
Mailing Address - Fax:708-349-9201
Practice Address - Street 1:10001 W 143RD ST
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-2026
Practice Address - Country:US
Practice Address - Phone:708-349-2600
Practice Address - Fax:708-349-9201
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046006582152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILCN3870OtherRR MEDICARE GROUP
ILDA8522OtherRR MEDICARE GROUP ORLAND
IL0363241858OtherTAX ID OAK LAWN
IL0618250001OtherDME OAK LAWN
IL1148260001OtherDME ORLAND PARK
IL0410022825OtherRR MEDICAR IND. OAKLAWN
IL985800OtherMEDICARE PROVIDER GRP#OP
IL0410021948OtherRR MEDICARE IND. ORLAND
IL508980OtherMEDICARE PROVIDER GRP#OL
IL0363448367OtherTAX ID ORLAND PK
IL508980OtherMEDICARE PROVIDER GRP#OL
IL985800OtherMEDICARE PROVIDER GRP#OP
IL985820Medicare PIN