Healthcare Provider Details

I. General information

NPI: 1992674253
Provider Name (Legal Business Name): GIACOMO CILLIANI OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2025
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 SPRING HILL RING RD STE 2020
WEST DUNDEE IL
60118-1297
US

IV. Provider business mailing address

30 W PEBBLE BEACH CIR APT 203
GLENDALE HEIGHTS IL
60139-3626
US

V. Phone/Fax

Practice location:
  • Phone: 847-426-0227
  • Fax: 847-426-0299
Mailing address:
  • Phone: 909-963-9470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046.012047
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: