Provider Demographics
NPI:1689723884
Name:SAJDECKI, LAWRENCE JOHN (OD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:JOHN
Last Name:SAJDECKI
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 1:1121 MOORLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SHOREWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60431-8613
Mailing Address - Country:US
Mailing Address - Phone:815-774-8832
Mailing Address - Fax:
Practice Address - Street 1:102 STRATFORD SQUARE MALL
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-2202
Practice Address - Country:US
Practice Address - Phone:630-893-7608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
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
ILT38948Medicare UPIN