Provider Demographics
NPI:1336568278
Name:BOKSA, ANASTASIA (OD)
Entity Type:Individual
Prefix:
First Name:ANASTASIA
Middle Name:
Last Name:BOKSA
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 1:30 E HURON ST
Mailing Address - Street 2:APT 3605
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2766
Mailing Address - Country:US
Mailing Address - Phone:847-714-7079
Mailing Address - Fax:
Practice Address - Street 1:141 W JACKSON BLVD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60604-2992
Practice Address - Country:US
Practice Address - Phone:312-427-9555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-08
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046010770152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist