Basic Information
| Provider Information | |||||||||
| NPI: | 1760677066 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VELICK | ||||||||
| FirstName: | MARNEE | ||||||||
| MiddleName: | CYD | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | O.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 146 CENTER ST | ||||||||
| Address2: | |||||||||
| City: | GRAYSLAKE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600303665 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8475482770 | ||||||||
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| Practice Location | |||||||||
| Address1: | 910 GREEN BAY RD | ||||||||
| Address2: | |||||||||
| City: | WINNETKA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600931719 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8479990234 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/10/2007 | ||||||||
| LastUpdateDate: | 01/25/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 046008939 | IL | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 8825444 | 01 | ID | MULTIPLAN | OTHER | 1636706 | 01 | IL | BCBS | OTHER | 7235044 | 01 | IL | AETNA | OTHER | 211019 | 01 | IL | MEDICARE GROUP | OTHER |