Provider Demographics
NPI:1699776203
Name:LAU, CESAR L (OD)
Entity type:Individual
Prefix:
First Name:CESAR
Middle Name:L
Last Name:LAU
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 1:4968 N MILWAUKEE AVE
Mailing Address - Street 2:UNIT 1 S
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-2383
Mailing Address - Country:US
Mailing Address - Phone:773-283-4053
Mailing Address - Fax:773-283-4588
Practice Address - Street 1:4968 N MILWAUKEE AVE
Practice Address - Street 2:UNIT 1 S
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-2383
Practice Address - Country:US
Practice Address - Phone:773-283-4053
Practice Address - Fax:773-283-4588
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-04
Last Update Date:2024-09-20
Deactivation Date:2006-05-10
Deactivation Code:
Reactivation Date:2006-05-18
Provider Licenses
StateLicense IDTaxonomies
IL046-008646152WP0200X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0555710001Medicare NSC
IL331180Medicare ID - Type Unspecified
ILU43840Medicare UPIN