Healthcare Provider Details

I. General information

NPI: 1811185770
Provider Name (Legal Business Name): RHMOELLERENTERPRISES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2007
Last Update Date: 11/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 OAKBROOK CTR #204
OAK BROOK IL
60523-4716
US

IV. Provider business mailing address

120 OAKBROOK CTR #204
OAK BROOK IL
60523-4716
US

V. Phone/Fax

Practice location:
  • Phone: 630-573-0360
  • Fax:
Mailing address:
  • Phone: 630-573-0360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RAYMOND HENRY MOELLER
Title or Position: OWNER
Credential: MD
Phone: 630-573-0360