Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | IL |
NPI | 1003975913 |
---|---|
Provider Name | Dr. Maria Pica |
First Address | St. Charles, IL 60175 |
Second Address | St. Charles, IL 60175 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2006 |
Last Update Date | 27/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4519570 | BCBS (01) | IL |
46008764 | (05) | IL |
U63133 | (02) | IL |