Provider Demographics
NPI:1134397904
Name:LAUREY L. SCHILLMAN, O.D., P.C.
Entity type:Organization
Organization Name:LAUREY L. SCHILLMAN, O.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAUREY
Authorized Official - Middle Name:L
Authorized Official - Last Name:SCHILLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:708-474-7574
Mailing Address - Street 1:18155 ROY ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:LANSING
Mailing Address - State:IL
Mailing Address - Zip Code:60438-2376
Mailing Address - Country:US
Mailing Address - Phone:708-474-7574
Mailing Address - Fax:708-474-4777
Practice Address - Street 1:18155 ROY ST
Practice Address - Street 2:SUITE 3
Practice Address - City:LANSING
Practice Address - State:IL
Practice Address - Zip Code:60438-2376
Practice Address - Country:US
Practice Address - Phone:708-474-7574
Practice Address - Fax:708-474-4777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-14
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL46-8066332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0792110001Medicare NSC