Provider Demographics
NPI:1700950169
Name:DONLEA, CHARLES (OD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:DONLEA
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 1:1120 W LAKE COOK RD STE C
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-1970
Mailing Address - Country:US
Mailing Address - Phone:847-459-6060
Mailing Address - Fax:847-459-9797
Practice Address - Street 1:1120 W LAKE COOK RD STE C
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-1970
Practice Address - Country:US
Practice Address - Phone:847-459-6060
Practice Address - Fax:847-459-9797
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046009194152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU87383Medicare UPIN