Provider Demographics
NPI:1184761215
Name:DEMAIO, LETICIA MAEZ (OD)
Entity type:Individual
Prefix:DR
First Name:LETICIA
Middle Name:MAEZ
Last Name:DEMAIO
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 1:905 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-3347
Mailing Address - Country:US
Mailing Address - Phone:630-629-3030
Mailing Address - Fax:630-629-1941
Practice Address - Street 1:905 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-3347
Practice Address - Country:US
Practice Address - Phone:630-629-3030
Practice Address - Fax:630-629-1941
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4682990001Medicare NSC
IL569500Medicare PIN