Healthcare Provider Details

I. General information

NPI: 1427196856
Provider Name (Legal Business Name): HR OPTICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 04/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2240 GATEWAY DR
SYCAMORE IL
60178-3103
US

IV. Provider business mailing address

2240 GATEWAY DR
SYCAMORE IL
60178-3103
US

V. Phone/Fax

Practice location:
  • Phone: 815-756-8571
  • Fax: 815-756-1790
Mailing address:
  • Phone: 815-756-5897
  • Fax: 815-756-6263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK C. RAFFERTY
Title or Position: OPTOMETRIST
Credential:
Phone: 815-756-5897