Provider Demographics
NPI:1669536306
Name:PELITSKY, STEVE (OD)
Entity type:Individual
Prefix:
First Name:STEVE
Middle Name:
Last Name:PELITSKY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1648 RIVERSIDE CT
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-2034
Mailing Address - Country:US
Mailing Address - Phone:847-924-7988
Mailing Address - Fax:847-259-7211
Practice Address - Street 1:704 E RAND RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-4006
Practice Address - Country:US
Practice Address - Phone:847-259-3933
Practice Address - Fax:847-259-7211
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL046-009057152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL121028Medicare UPIN