Provider Demographics
NPI:1376550061
Name:MACEK, MICHAEL D (OD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:MACEK
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 1:4958 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-3508
Mailing Address - Country:US
Mailing Address - Phone:630-737-1001
Mailing Address - Fax:630-737-1003
Practice Address - Street 1:4958 FOREST AVE
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-3508
Practice Address - Country:US
Practice Address - Phone:630-737-1001
Practice Address - Fax:630-737-1003
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046008708152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1801997655OtherBCBS
IL2234272OtherBCBS
IL1801997655OtherBCBS
IL5797390001Medicare NSC
IL1376550061Medicare Oscar/Certification
IL1376550061Medicare PIN