Provider Demographics
NPI:1881619427
Name:SIKORSKI, MARTIN J (OD)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:J
Last Name:SIKORSKI
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 1:440 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-5124
Mailing Address - Country:US
Mailing Address - Phone:630-469-4141
Mailing Address - Fax:630-469-2015
Practice Address - Street 1:440 N MAIN ST
Practice Address - Street 2:
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-5124
Practice Address - Country:US
Practice Address - Phone:630-469-4141
Practice Address - Fax:630-469-2015
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046.006197152W00000X, 152WC0802X, 152WP0200X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0410007883OtherRAILROAD MEDICARE
IL0410007883OtherRAILROAD MEDICARE
IL651040Medicare ID - Type UnspecifiedO.D.
IL0449300001Medicare NSC