Provider Demographics
NPI:1710651906
Name:HANACEK, DANIEL (OD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:HANACEK
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 1:10235 KEDVALE AVE
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-4239
Mailing Address - Country:US
Mailing Address - Phone:708-945-9121
Mailing Address - Fax:
Practice Address - Street 1:2650 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-2090
Practice Address - Country:US
Practice Address - Phone:773-697-9735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-02
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046011557152W00000X
IL04601157152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist