Provider Demographics
NPI:1932258019
Name:TANCIOCO-ROKOSZ, ELAINE ANNE (OD)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:ANNE
Last Name:TANCIOCO-ROKOSZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ELAINE
Other - Middle Name:ANNE
Other - Last Name:TANCIOCO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:402 E PINE LAKE CIR
Mailing Address - Street 2:
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-1202
Mailing Address - Country:US
Mailing Address - Phone:847-968-2575
Mailing Address - Fax:
Practice Address - Street 1:9450 SKOKIE BLVD
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-1311
Practice Address - Country:US
Practice Address - Phone:847-677-7202
Practice Address - Fax:847-677-1258
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU79886Medicare UPIN
ILL82206Medicare ID - Type Unspecified