Provider Demographics
NPI:1689241374
Name:ZAGORSKI, MARIA KATHLEEN (OD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:KATHLEEN
Last Name:ZAGORSKI
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 1:518 N BURR OAK ST
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:IL
Mailing Address - Zip Code:62293-1739
Mailing Address - Country:US
Mailing Address - Phone:618-420-3288
Mailing Address - Fax:
Practice Address - Street 1:10900 LINCOLN TRL
Practice Address - Street 2:
Practice Address - City:FAIRVIEW HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:62208-2042
Practice Address - Country:US
Practice Address - Phone:618-398-5005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-10
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046.011511152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist