Provider Demographics
NPI:1912237918
Name:STRYJECKI, AGNIESZKA
Entity type:Individual
Prefix:
First Name:AGNIESZKA
Middle Name:
Last Name:STRYJECKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 LANDOVER PKWY
Mailing Address - Street 2:SUITE B1
Mailing Address - City:HAWTHORN WOODS
Mailing Address - State:IL
Mailing Address - Zip Code:60047-7513
Mailing Address - Country:US
Mailing Address - Phone:847-550-6558
Mailing Address - Fax:847-847-2210
Practice Address - Street 1:60 LANDOVER PKWY
Practice Address - Street 2:SUITE B1
Practice Address - City:HAWTHORN WOODS
Practice Address - State:IL
Practice Address - Zip Code:60047-7513
Practice Address - Country:US
Practice Address - Phone:847-550-6558
Practice Address - Fax:847-847-2210
Is Sole Proprietor?:No
Enumeration Date:2010-01-13
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL04900820001156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician