Provider Demographics
NPI:1053894865
Name:CESAR, CINDY ANN (OD)
Entity type:Individual
Prefix:
First Name:CINDY
Middle Name:ANN
Last Name:CESAR
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14407 W SOUTH STREET RD
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:IL
Mailing Address - Zip Code:60098-8993
Mailing Address - Country:US
Mailing Address - Phone:815-482-5336
Mailing Address - Fax:
Practice Address - Street 1:1349 W LANE RD
Practice Address - Street 2:
Practice Address - City:MACHESNEY PARK
Practice Address - State:IL
Practice Address - Zip Code:61115-1621
Practice Address - Country:US
Practice Address - Phone:815-877-0016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-09
Last Update Date:2019-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046.011246152WC0802X, 152WL0500X, 156FC0800X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No156FC0800XEye and Vision Services ProvidersTechnician/TechnologistContact Lens