Provider Demographics
NPI:1376644831
Name:OPLAWSKI, JOHN A (OD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:OPLAWSKI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6763 N MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-4418
Mailing Address - Country:US
Mailing Address - Phone:847-626-0422
Mailing Address - Fax:847-626-0474
Practice Address - Street 1:6763 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-4418
Practice Address - Country:US
Practice Address - Phone:847-626-0422
Practice Address - Fax:847-626-0474
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046008018152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046008018Medicaid
IL776320Medicare ID - Type UnspecifiedMEDICARE NUMBER
IL046008018Medicaid
ILT38923Medicare UPIN