Provider Demographics
NPI:1740270453
Name:TRZEPACZ, STEVEN J (OD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:J
Last Name:TRZEPACZ
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 1:223 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STREATOR
Mailing Address - State:IL
Mailing Address - Zip Code:61364-2950
Mailing Address - Country:US
Mailing Address - Phone:815-673-1591
Mailing Address - Fax:
Practice Address - Street 1:223 E MAIN ST
Practice Address - Street 2:
Practice Address - City:STREATOR
Practice Address - State:IL
Practice Address - Zip Code:61364-2950
Practice Address - Country:US
Practice Address - Phone:815-673-1591
Practice Address - Fax:815-672-5203
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-24
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL000046-7823152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046-7823Medicaid
IL5084023OtherBLUE CROSS
IL046-7823Medicaid
758-380Medicare PIN
6601400001Medicare NSC