MEDICARE: CAROLYN SZUMANSKI OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist		IL

General Provider Information

NPI Number	:	1902928880
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLYN SZUMANSKI OD

Provider Business Mailing Address
First Line	:	11103 WEST AVE
Second Line	:	STE. 6
City	:	SAN ANTONIO
State	:	TX
Zip	:	78213-1370
Country	:	US
Telephone Number	:	210-524-6663
Fax Number	:	210-524-6587

Provider Business Practice Location Address
First Line	:	101 CHICAGO RIDGE MALL
Second Line	:	STE E-1
City	:	CHICAGO RIDGE
State	:	IL
Zip	:	60415-2603
Country	:	US
Telephone Number	:	708-423-0791
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	07/08/2007

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