Provider Demographics
NPI:1861483992
Name:LOMAZOV, EUGENIA (OD)
Entity Type:Individual
Prefix:DR
First Name:EUGENIA
Middle Name:
Last Name:LOMAZOV
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 1:58 S ARLINGTON HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-1455
Mailing Address - Country:US
Mailing Address - Phone:847-368-9999
Mailing Address - Fax:847-368-9920
Practice Address - Street 1:58 S ARLINGTON HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-1455
Practice Address - Country:US
Practice Address - Phone:847-368-9999
Practice Address - Fax:847-368-9920
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-28
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-008934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU79884Medicare UPIN
IL579420Medicare ID - Type UnspecifiedPROVIDER NUMBER