Provider Demographics
NPI:1255539292
Name:HALIKIAS, TANYA (OD)
Entity type:Individual
Prefix:DR
First Name:TANYA
Middle Name:
Last Name:HALIKIAS
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 1:5450 WOLF RD
Mailing Address - Street 2:
Mailing Address - City:WESTERN SPRINGS
Mailing Address - State:IL
Mailing Address - Zip Code:60558-1852
Mailing Address - Country:US
Mailing Address - Phone:708-820-2020
Mailing Address - Fax:708-820-0321
Practice Address - Street 1:5450 WOLF RD
Practice Address - Street 2:
Practice Address - City:WESTERN SPRINGS
Practice Address - State:IL
Practice Address - Zip Code:60558-1852
Practice Address - Country:US
Practice Address - Phone:312-949-7168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046009983152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046009983Medicaid
ILK40197Medicare PIN