Healthcare Provider Details

I. General information

NPI: 1942342886
Provider Name (Legal Business Name): MARITZA MEIFERT O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 FOX VALLEY CTR
AURORA IL
60504-4187
US

IV. Provider business mailing address

3919 HIGHKNOB CIR
NAPERVILLE IL
60564-8247
US

V. Phone/Fax

Practice location:
  • Phone: 630-851-0305
  • Fax:
Mailing address:
  • Phone: 630-904-1053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: