Provider Demographics
NPI:1154407880
Name:SIDRYS, LINAS A (MD)
Entity type:Individual
Prefix:
First Name:LINAS
Middle Name:A
Last Name:SIDRYS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5706 111TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60415-2407
Mailing Address - Country:US
Mailing Address - Phone:708-636-6622
Mailing Address - Fax:
Practice Address - Street 1:5706 111TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60415-2407
Practice Address - Country:US
Practice Address - Phone:708-636-6622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-058239207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL05032013OtherBLUE CROSS
IL180009600OtherRAILROAD MEDICARE
IL207W00000XOtherTAXONOMY CODE
IL036-058239OtherILLINOIS LCENSE
IL180046260OtherRAILROAD MEDICARE
IL21629784OtherBLUE CROSS
IL036-058239OtherILLINOIS LCENSE
IL21629784OtherBLUE CROSS
IL207W00000XOtherTAXONOMY CODE
IL180046260OtherRAILROAD MEDICARE
IL568870Medicare PIN