Healthcare Provider Details

I. General information

NPI: 1811670698
Provider Name (Legal Business Name): NAZAR MAKSYMKIV
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2023
Last Update Date: 05/23/2026
Certification Date: 05/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3340 MALL LOOP DR SPC 1442
JOLIET IL
60431-1092
US

IV. Provider business mailing address

17423 LONGWOOD DR
ORLAND PARK IL
60467-8782
US

V. Phone/Fax

Practice location:
  • Phone: 815-436-1582
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046.011744
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: