Provider Demographics
NPI:1629149224
Name:ALBANESE, MICHELE (OD)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:ALBANESE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:
Other - Last Name:OTTOLINO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:1298 FOX VALLEY CTR
Mailing Address - Street 2:FOX VALLEY CENTER
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-4184
Mailing Address - Country:US
Mailing Address - Phone:630-851-8301
Mailing Address - Fax:630-851-8329
Practice Address - Street 1:1402 BUTTERFIELD RD
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-1031
Practice Address - Country:US
Practice Address - Phone:630-629-2025
Practice Address - Fax:630-629-7640
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU36151Medicare UPIN