Healthcare Provider Details

I. General information

NPI: 1295877132
Provider Name (Legal Business Name): MICHAEL J WOJCIAK O.D.
Entity Type: Individual
Gender: Male
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

3 WOODFIELD MALL JCPENNEY OPTICAL
SCHAUMBURG IL
60173-5012
US

IV. Provider business mailing address

7513 BAIMBRIDGE DR
DOWNERS GROVE IL
60516-4453
US

V. Phone/Fax

Practice location:
  • Phone: 847-240-5655
  • Fax: 847-240-5156
Mailing address:
  • Phone: 630-241-1937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046.007953
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: