Provider Demographics
NPI:1851077440
Name:STRUPEK, CAILYN (OD)
Entity Type:Individual
Prefix:
First Name:CAILYN
Middle Name:
Last Name:STRUPEK
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 1:1940 N SHEFFIELD AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-5019
Mailing Address - Country:US
Mailing Address - Phone:703-953-4537
Mailing Address - Fax:
Practice Address - Street 1:9400 S ROBERTS RD
Practice Address - Street 2:
Practice Address - City:HICKORY HILLS
Practice Address - State:IL
Practice Address - Zip Code:60457-2326
Practice Address - Country:US
Practice Address - Phone:708-598-1322
Practice Address - Fax:708-598-0557
Is Sole Proprietor?:No
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046011728152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist