Healthcare Provider Details

I. General information

NPI: 1144077496
Provider Name (Legal Business Name): DIANA M REGNERY OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2024
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3450 LACEY RD
DOWNERS GROVE IL
60515-5430
US

IV. Provider business mailing address

3450 LACEY RD
DOWNERS GROVE IL
60515-5430
US

V. Phone/Fax

Practice location:
  • Phone: 630-743-4500
  • Fax: 623-806-7689
Mailing address:
  • Phone: 630-743-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046011864
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: