Provider Demographics
NPI:1700996592
Name:SAGAL-MARSHALKOVICH, HELEN (OD)
Entity type:Individual
Prefix:DR
First Name:HELEN
Middle Name:
Last Name:SAGAL-MARSHALKOVICH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2368 ASBURY RD
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-6004
Mailing Address - Country:US
Mailing Address - Phone:847-205-7815
Mailing Address - Fax:
Practice Address - Street 1:930 E RAND RD
Practice Address - Street 2:
Practice Address - City:MT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-2500
Practice Address - Country:US
Practice Address - Phone:847-590-0007
Practice Address - Fax:847-590-0009
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL605760Medicare PIN