Provider Demographics
NPI:1659420925
Name:MOKAYA, ELIZABETH S (OD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:S
Last Name:MOKAYA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:A
Other - Last Name:SALMON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1225 N ORLEANS ST
Mailing Address - Street 2:#501
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-7554
Mailing Address - Country:US
Mailing Address - Phone:312-961-7164
Mailing Address - Fax:
Practice Address - Street 1:3136 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-3117
Practice Address - Country:US
Practice Address - Phone:773-871-8210
Practice Address - Fax:773-871-4290
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-009864152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist