Healthcare Provider Details

I. General information

NPI: 1053413930
Provider Name (Legal Business Name): ANTHONY J PRASNIKAR OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 11/11/2024
Certification Date: 11/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6321 FAIRVIEW AVE SUITE A
WESTMONT IL
60559-2886
US

IV. Provider business mailing address

6425 DAVANE CT
DOWNERS GROVE IL
60516-3057
US

V. Phone/Fax

Practice location:
  • Phone: 630-852-0102
  • Fax: 630-852-0260
Mailing address:
  • Phone: 630-915-0157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number046-007544
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number046-007544
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number046-007544
License Number StateIL
# 4
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046-007544
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number046-007544
License Number StateIL
# 6
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number046-007544
License Number StateIL
# 7
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License Number046-007544
License Number StateIL
# 8
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number046-007544
License Number StateIL
# 9
Primary TaxonomyN
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License Number046-007544
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: