1104989110 NPI number — DEBORAH ANN TOTOS O.D.

Table of content: DEBORAH ANN TOTOS O.D. (NPI 1104989110)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104989110 NPI number — DEBORAH ANN TOTOS O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TOTOS
Provider First Name:
DEBORAH
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MANN
Provider Other First Name:
DEBORAH
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1104989110
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1600 N STATE ROUTE 50
Provider Second Line Business Mailing Address:
#580
Provider Business Mailing Address City Name:
BOURBONNAIS
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60914-9307
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-935-0404
Provider Business Mailing Address Fax Number:
815-935-0489

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1600 N STATE ROUTE 50
Provider Second Line Business Practice Location Address:
RM 580 NORTHFIELD SQUARE
Provider Business Practice Location Address City Name:
BOURBONNAIS
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60914-9307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-935-0404
Provider Business Practice Location Address Fax Number:
815-935-0489
Provider Enumeration Date:
12/19/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  046-008540 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)