Provider Demographics
NPI:1780641282
Name:GIUSEFFI, VITO MARK (O D)
Entity Type:Individual
Prefix:DR
First Name:VITO
Middle Name:MARK
Last Name:GIUSEFFI
Suffix:
Gender:M
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:498 CAPITAL LN
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-4495
Mailing Address - Country:US
Mailing Address - Phone:847-223-9181
Mailing Address - Fax:
Practice Address - Street 1:18 S EVERGREEN AVE
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-1428
Practice Address - Country:US
Practice Address - Phone:847-253-8500
Practice Address - Fax:847-253-8538
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2007-10-17
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
IL4923647OtherBCBS
IL0040030638OtherBCBS
IL0040030638OtherBCBS
IL4923647OtherBCBS