Provider Demographics
NPI:1265440374
Name:LESEIKO-OWERKO, IRENA A (OD)
Entity type:Individual
Prefix:DR
First Name:IRENA
Middle Name:A
Last Name:LESEIKO-OWERKO
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 1:2308 W CHICAGO AVENUE
Mailing Address - Street 2:UNIT 1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-4722
Mailing Address - Country:US
Mailing Address - Phone:773-486-2147
Mailing Address - Fax:773-486-4486
Practice Address - Street 1:2308 W CHICAGO AVENUE
Practice Address - Street 2:UNIT 1
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-4722
Practice Address - Country:US
Practice Address - Phone:773-486-2147
Practice Address - Fax:773-486-4486
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046007930152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046007930Medicaid
IL046007930Medicaid
ILK14394Medicare ID - Type Unspecified
ILT38699Medicare UPIN