Provider Demographics
NPI:1053413930
Name:PRASNIKAR, ANTHONY J (OD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:J
Last Name:PRASNIKAR
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6425 DAVANE CT
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60516-3057
Mailing Address - Country:US
Mailing Address - Phone:630-915-0157
Mailing Address - Fax:
Practice Address - Street 1:6321 FAIRVIEW AVE
Practice Address - Street 2:SUITE A
Practice Address - City:WESTMONT
Practice Address - State:IL
Practice Address - Zip Code:60559-2886
Practice Address - Country:US
Practice Address - Phone:630-852-0102
Practice Address - Fax:630-852-0260
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-007544152WC0802X, 152WP0200X, 152WS0006X, 152WV0400X, 152WX0102X, 332B00000X, 332BC3200X, 332H00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL742450Medicare ID - Type UnspecifiedMEDICARE ID
IL410006478Medicare ID - Type UnspecifiedRAILROAD MEDICARE ID
ILT38400Medicare UPIN