Provider Demographics
NPI:1861484743
Name:CAPELLANI, JOHN P (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:P
Last Name:CAPELLANI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3541 ROSE ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:FRANKLIN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60131
Mailing Address - Country:US
Mailing Address - Phone:847-678-0808
Mailing Address - Fax:847-678-0828
Practice Address - Street 1:3541 ROSE ST
Practice Address - Street 2:SUITE B
Practice Address - City:FRANKLIN PARK
Practice Address - State:IL
Practice Address - Zip Code:60131
Practice Address - Country:US
Practice Address - Phone:847-678-0808
Practice Address - Fax:847-678-0828
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0046-009006152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL398790Medicare ID - Type Unspecified
ILU68087Medicare UPIN