Individual
STEPHANIE A WIECZOREK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
7601 S CICERO AVE, FORD CITY MALL, CHICAGO, IL 60652-1022
(773) 582-8030
(773) 582-9396
Mailing address
1719 W DIVERSEY PKWY, CHICAGO, IL 60614-1009
(312) 498-9363
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046-009385
IL
Other
Enumeration date
12/19/2006
Last updated
05/21/2010
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