MEDICARE: RONALD FARY OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	18002261A	IN
2	152W00000X	Optometrist	046009911	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00380091	OTHER	IL	PALMETTO GBA / RR MEDICARE
6	P00380091	OTHER	IL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	410048585	OTHER	IN	RAILROAD / TRAVELERS
3	1622243	OTHER	IL	BCBS OF IL
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	000000306292	OTHER	IN	ANTHEM
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134108566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD FARY OD

Provider Business Mailing Address
First Line	:	6608 KANSAS AVE
Second Line	:
City	:	HAMMOND
State	:	IN
Zip	:	46323-1747
Country	:	US
Telephone Number	:	219-844-1684
Fax Number	:

Provider Business Practice Location Address
First Line	:	6601 N AVONDALE AVE STE 102
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60631-1567
Country	:	US
Telephone Number	:	773-792-1011
Fax Number	:	773-787-1311

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/13/2006
Last Update Date	:	02/23/2023

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Directions to “ RONALD FARY OD” Practice Location

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