Healthcare Provider Details

I. General information

NPI: 1629115951
Provider Name (Legal Business Name): RICHARD E WOJCIK OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 SPANGLER DR
ROMEOVILLE IL
60446
US

IV. Provider business mailing address

330 SPANGLER RD
ROMEOVILLE IL
60446-1840
US

V. Phone/Fax

Practice location:
  • Phone: 815-886-0800
  • Fax: 815-886-4493
Mailing address:
  • Phone: 815-886-0800
  • Fax: 815-886-4493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046006792
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: