Provider Demographics
NPI:1336228493
Name:SADOFSKY, HOWARD (OD)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:
Last Name:SADOFSKY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4005 W KANE AVE
Mailing Address - Street 2:SUITE F
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-6305
Mailing Address - Country:US
Mailing Address - Phone:815-385-9240
Mailing Address - Fax:815-385-7512
Practice Address - Street 1:4005 W KANE AVE
Practice Address - Street 2:SUITE F
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-6305
Practice Address - Country:US
Practice Address - Phone:815-385-9240
Practice Address - Fax:815-385-7512
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046007622152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL5615137Medicare UPIN
IL320420Medicare ID - Type UnspecifiedMEDICARE