Provider Demographics
NPI:1104989110
Name:TOTOS, DEBORAH ANN (OD)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ANN
Last Name:TOTOS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:ANN
Other - Last Name:MANN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1600 N STATE ROUTE 50
Mailing Address - Street 2:#580
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-9307
Mailing Address - Country:US
Mailing Address - Phone:815-935-0404
Mailing Address - Fax:815-935-0489
Practice Address - Street 1:1600 N STATE ROUTE 50
Practice Address - Street 2:RM 580 NORTHFIELD SQUARE
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-9307
Practice Address - Country:US
Practice Address - Phone:815-935-0404
Practice Address - Fax:815-935-0489
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-008540152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU51783Medicare UPIN