Provider Demographics
NPI:1477442747
Name:MORDARSKIY, STANISLAV (OD)
Entity type:Individual
Prefix:DR
First Name:STANISLAV
Middle Name:
Last Name:MORDARSKIY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2545 ERIE ST
Mailing Address - Street 2:
Mailing Address - City:RIVER GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60171-1713
Mailing Address - Country:US
Mailing Address - Phone:708-714-2205
Mailing Address - Fax:
Practice Address - Street 1:1701 N LARKIN AVE STE 105
Practice Address - Street 2:
Practice Address - City:CREST HILL
Practice Address - State:IL
Practice Address - Zip Code:60403-3457
Practice Address - Country:US
Practice Address - Phone:815-741-1140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-01
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046.011978152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist