Healthcare Provider Details

I. General information

NPI: 1366559502
Provider Name (Legal Business Name): DIANA F PENUELA-O'NEILL O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 01/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 STONEGATE RD
ALGONQUIN IL
60102-5614
US

IV. Provider business mailing address

245 STONEGATE RD
ALGONQUIN IL
60102-5614
US

V. Phone/Fax

Practice location:
  • Phone: 847-658-0120
  • Fax: 847-658-0610
Mailing address:
  • Phone: 847-658-0120
  • Fax: 847-658-0610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046-008362
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: