Healthcare Provider Details

I. General information

NPI: 1659488898
Provider Name (Legal Business Name): DIANA F PENUELA-ONEILL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 04/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 STONEGATE RD
ALGONQUIN IL
60102-5614
US

IV. Provider business mailing address

10620 TAURUS CT
WOODSTOCK IL
60098-8000
US

V. Phone/Fax

Practice location:
  • Phone: 847-658-0120
  • Fax: 847-658-0610
Mailing address:
  • Phone: 815-338-9936
  • Fax: 815-338-9904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. DIANA F PENUELA-ONEILL
Title or Position: PRESIDENT
Credential: O.D.
Phone: 847-658-0120