Provider Demographics
NPI:1790393841
Name:MADRO, SAMANTHA F (OD)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:F
Last Name:MADRO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1513 ILLINOIS ST
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60193-4670
Mailing Address - Country:US
Mailing Address - Phone:630-512-1987
Mailing Address - Fax:
Practice Address - Street 1:140 N NORTHWEST HWY
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-3342
Practice Address - Country:US
Practice Address - Phone:847-292-1805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-15
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046.011443152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist