Provider Demographics
NPI:1902091952
Name:BOBKO, SUSAN (OD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:BOBKO
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 1:7801 JOLIET DR N
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-4578
Mailing Address - Country:US
Mailing Address - Phone:708-267-3937
Mailing Address - Fax:708-429-0484
Practice Address - Street 1:16532 OAK PARK AVE
Practice Address - Street 2:STE 201
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-2273
Practice Address - Country:US
Practice Address - Phone:708-267-3937
Practice Address - Fax:708-429-0484
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-12
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046008341152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist