Provider Demographics
NPI:1154430353
Name:GIANCOLA, LAURA A (OD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:A
Last Name:GIANCOLA
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 1:29 S WEBSTER STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-5356
Mailing Address - Country:US
Mailing Address - Phone:630-357-3511
Mailing Address - Fax:630-357-0556
Practice Address - Street 1:29 S WEBSTER ST
Practice Address - Street 2:SUITE 200
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-5356
Practice Address - Country:US
Practice Address - Phone:630-357-3511
Practice Address - Fax:630-357-0556
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-008346152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU18748Medicare UPIN
ILK08321Medicare ID - Type Unspecified