Stephanie A Wieczorek, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

046-009385 Issued in IL

Practice address

7601 S Cicero Ave
Ford City Mall
Chicago, IL 60652-1022

Phone

(773) 582-8030

Fax

(773) 582-9396

NPI assigned

Dec 19, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Pearle Vision Inc

  • Eyewear Supplier
  • Fairview Heights, IL
  • NPI 1982744033
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166486400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1274400000000",
    "number": "1295898211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1719 W DIVERSEY PKWY",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606141009",
            "telephone_number": "312-498-9363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7601 S CICERO AVE",
            "address_2": "FORD CITY MALL",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606521022",
            "telephone_number": "773-582-8030",
            "fax_number": "773-582-9396"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIECZOREK",
        "first_name": "STEPHANIE",
        "middle_name": "A",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-19",
        "last_updated": "2010-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046-009385",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Olivia Widner, MC, LPC
• Katherine Wido
• Wendy Widom, MASTER OF ARTS
• Wiebusch Physical Therapy, Inc
• Malgorzata Wieczorek-Tlalka, DDS
• Martha Wiedlin, P.T.
• Margaret Anne Wiedmann, MD
• Thomas A Wiedrich, MD
• Margaret Wiedt, OTD, OTR/L
• Samantha Wiegand

• Optometrist in Chicago, IL
• Providers in Chicago, IL by specialty
• Optometrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.