Healthcare Provider Details

I. General information

NPI: 1134472996
Provider Name (Legal Business Name): PAMELA MARIE MARZEC O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2012
Last Update Date: 03/06/2023
Certification Date: 03/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 N PLAZA DR STE 100
SCHAUMBURG IL
60173-5403
US

IV. Provider business mailing address

4024 CONIFER DR
ELGIN IL
60124-3146
US

V. Phone/Fax

Practice location:
  • Phone: 847-413-2110
  • Fax: 847-413-2114
Mailing address:
  • Phone: 847-242-1692
  • Fax: 847-330-2236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3688-35
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG0033974
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number105503
License Number StateIA
# 4
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTPOP22
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0618002850
License Number StateVA
# 6
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number27OA00704300
License Number StateNJ
# 7
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV009099
License Number StateNY
# 8
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046010627
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: