Provider Demographics
NPI:1780633347
Name:VATIANOU, EVANGELOS (OD)
Entity Type:Individual
Prefix:DR
First Name:EVANGELOS
Middle Name:
Last Name:VATIANOU
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 1:2003 MONTGOMERY RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-9078
Mailing Address - Country:US
Mailing Address - Phone:630-892-1401
Mailing Address - Fax:630-892-1404
Practice Address - Street 1:1000 RANDALL RD STE 100
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-2591
Practice Address - Country:US
Practice Address - Phone:630-232-1282
Practice Address - Fax:630-232-7011
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046009329152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046009329Medicaid
IL046009329Medicaid