Provider Demographics
NPI:1629206628
Name:MANASTERSKY, NATALKA A (OD)
Entity Type:Individual
Prefix:
First Name:NATALKA
Middle Name:A
Last Name:MANASTERSKY
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 1:1700 E WEST RD
Mailing Address - Street 2:
Mailing Address - City:CALUMET CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60409-5431
Mailing Address - Country:US
Mailing Address - Phone:708-891-3330
Mailing Address - Fax:708-891-0904
Practice Address - Street 1:1700 E WEST RD
Practice Address - Street 2:
Practice Address - City:CALUMET CITY
Practice Address - State:IL
Practice Address - Zip Code:60409-5431
Practice Address - Country:US
Practice Address - Phone:708-891-3330
Practice Address - Fax:708-891-0904
Is Sole Proprietor?:No
Enumeration Date:2009-06-29
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046010241152W00000X, 152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046010241Medicaid
IL046010241Medicaid