Provider Demographics
NPI:1972651636
Name:KULBAK, ADALINA (OD)
Entity Type:Individual
Prefix:DR
First Name:ADALINA
Middle Name:
Last Name:KULBAK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ADA
Other - Middle Name:
Other - Last Name:JOSIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9436 KARLOV AVE
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1417
Mailing Address - Country:US
Mailing Address - Phone:224-522-2722
Mailing Address - Fax:
Practice Address - Street 1:9436 KARLOV AVE
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1417
Practice Address - Country:US
Practice Address - Phone:224-522-2722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-008697152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046008697Medicaid
ILIL8106Medicare PIN