Individual
DR. PAULINE PAKLA BUBANKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
1230 N CEDAR RD UNIT A, NEW LENOX, IL 60451-1272
(815) 485-6533
(815) 485-6534
Mailing address
1230 N CEDAR RD UNIT A, NEW LENOX, IL 60451-1272
(815) 485-6533
(815) 485-6534
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046009290
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
046009290
STATE LICENSE
IL
Enumeration date
10/26/2006
Last updated
11/22/2024
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