Provider Demographics
NPI:1700052834
Name:DONALD V MADUZIA O.D. P.C.
Entity Type:Organization
Organization Name:DONALD V MADUZIA O.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMOTRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:V
Authorized Official - Last Name:MADUZIA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:630-323-3202
Mailing Address - Street 1:203 RAILROAD AVENUE
Mailing Address - Street 2:
Mailing Address - City:CLARENDON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60514
Mailing Address - Country:US
Mailing Address - Phone:630-323-3202
Mailing Address - Fax:630-321-0512
Practice Address - Street 1:203 RAILROAD AVENUE
Practice Address - Street 2:
Practice Address - City:CLARENDON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60514
Practice Address - Country:US
Practice Address - Phone:630-323-3202
Practice Address - Fax:630-321-0512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-08
Last Update Date:2008-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046.007789152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
4123680001OtherDURABLE GOODS
2284078OtherBCBS
IL2284078OtherBC/BS
IL4123680001Medicare NSC
2284078OtherBCBS
ILT38963Medicare UPIN
IL2284078OtherBC/BS
778050Medicare PIN