Individual
RICHARD MARK ZAJICEK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
3141 S VETERANS PKWY, SPRINGFIELD, IL 62704-6565
(217) 793-2273
(217) 793-2278
Mailing address
720 WELLINGTON AVE, UNIT 415, ELK GROVE VILLAGE, IL 60007-3366
(847) 340-0877
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046007387
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
046007387
STATE GENERAL LICENSE
IL
01
—
047933072
IL ANCILLARY LIC ALGONQUI
IL
01
—
1684405
BCBS PROVIDER NUMBER
IL
01
—
346000315
STATE THERAPEUTIC LICENSE
IL
01
—
346002621
IL ANC THERAP ALGONQUIN
IL
Enumeration date
02/01/2007
Last updated
03/07/2023
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