Provider Demographics
NPI:1982017851
Name:MACCI, TEHNEIYAT (OD)
Entity Type:Individual
Prefix:DR
First Name:TEHNEIYAT
Middle Name:
Last Name:MACCI
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 1:152 S BLOOMINGDALE RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-1481
Mailing Address - Country:US
Mailing Address - Phone:630-980-4446
Mailing Address - Fax:630-980-2313
Practice Address - Street 1:152 S BLOOMINGDALE RD
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-1481
Practice Address - Country:US
Practice Address - Phone:630-980-4446
Practice Address - Fax:630-980-2313
Is Sole Proprietor?:No
Enumeration Date:2014-06-08
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046010772152W00000X
IL046.010772152WC0802X, 152WP0200X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics