Healthcare Provider Details

I. General information

NPI: 1154411312
Provider Name (Legal Business Name): JAMES ALAN VROEGH O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 01/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15410 S HARLEM AVE
ORLAND PARK IL
60462-4333
US

IV. Provider business mailing address

3605 SPYGLASS CIR
PALOS HEIGHTS IL
60463-3138
US

V. Phone/Fax

Practice location:
  • Phone: 708-633-0060
  • Fax: 708-633-0077
Mailing address:
  • Phone: 708-597-9778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046007652
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: