Provider Demographics
NPI:1851431571
Name:OKSANA MENSHEHA, M.D., S.C.
Entity Type:Organization
Organization Name:OKSANA MENSHEHA, M.D., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OKSANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MENSHEHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-367-6780
Mailing Address - Street 1:1117 S MILWAUKEE AVE
Mailing Address - Street 2:FORUM SQUARE A-10
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-3798
Mailing Address - Country:US
Mailing Address - Phone:847-367-6780
Mailing Address - Fax:847-367-6861
Practice Address - Street 1:1117 S MILWAUKEE AVE
Practice Address - Street 2:FORUM SQUARE A-10
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-3798
Practice Address - Country:US
Practice Address - Phone:847-367-6780
Practice Address - Fax:847-367-6861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36053536152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK14581Medicare ID - Type Unspecified
IL5359940001Medicare NSC
ILC38314Medicare UPIN