Provider Demographics
NPI:1629115951
Name:WOJCIK, RICHARD E (OD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:E
Last Name:WOJCIK
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 1:330 SPANGLER RD
Mailing Address - Street 2:
Mailing Address - City:ROMEOVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60446-1840
Mailing Address - Country:US
Mailing Address - Phone:815-886-0800
Mailing Address - Fax:815-886-4493
Practice Address - Street 1:330 SPANGLER DR
Practice Address - Street 2:
Practice Address - City:ROMEOVILLE
Practice Address - State:IL
Practice Address - Zip Code:60446
Practice Address - Country:US
Practice Address - Phone:815-886-0800
Practice Address - Fax:815-886-4493
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046006792152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046006792Medicaid
046-006792OtherILL. LISCENSE
MW0225943OtherDEA
IL0611780002Medicare NSC
IL657011Medicare PIN
IL657010Medicare PIN
IL0611780001Medicare NSC
T37529Medicare UPIN
IL046006792Medicaid