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General NPI Number Information
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NPI Number | 1033417845
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Entity Type | Organization
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Legal Business Name | DONALD V MADUZIA OD PC
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Dates
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Enumeration Date | 03/02/2011
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Last Update Date | 03/02/2011
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Provider Practice Location Address
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Address Line | 203 RAILROAD AVE
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City | CLARENDON HILLS
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State | IL
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Zip | 60514-1301
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Country | US
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Telephone | 630-323-3202
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Fax | 630-321-0512
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Provider Business Mailing Address
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Address Line | 203 RAILROAD AVE
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City | CLARENDON HILLS
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State | IL
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Zip | 60514-1301
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Country | US
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Telephone | 630-323-3202
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Fax | 630-321-0512
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Authorized Official
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Title or Position | OPTOMETRIST/PRESIDENT
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Name | DR. DONALD V. MADUZIA
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Credential | O.D.
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Telephone | 630-323-3202
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 046.007789
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 046-007789
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License Number State | IL
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