Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 046011186 | IL |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 046011186 | IL |
NPI | 1184038606 |
---|---|
Provider Name | John Gialousakis |
First Address | Downers Grove, IL 60515-5430 |
Second Address | Downers Grove, IL 60515-5430 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2014 |
Last Update Date | 05/06/2019 |