Healthcare Provider Details

I. General information

NPI: 1275758260
Provider Name (Legal Business Name): VALENCIA M RAY MD SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8541 S STATE ST SUITE 5
CHICAGO IL
60619-5665
US

IV. Provider business mailing address

8541 S STATE ST SUITE 5
CHICAGO IL
60619-5665
US

V. Phone/Fax

Practice location:
  • Phone: 773-873-0052
  • Fax: 773-873-0054
Mailing address:
  • Phone: 773-873-0052
  • Fax: 773-873-0054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. VALENCIA RAY
Title or Position: PHYSICIAN OWNER
Credential: MD
Phone: 630-251-3822