Healthcare Provider Details

I. General information

NPI: 1982963203
Provider Name (Legal Business Name): VROEGH FAMILY EYECARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2012
Last Update Date: 01/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17322 OAK PARK AVE
TINLEY PARK IL
60477-3404
US

IV. Provider business mailing address

17322 OAK PARK AVE
TINLEY PARK IL
60477-3404
US

V. Phone/Fax

Practice location:
  • Phone: 708-614-7900
  • Fax:
Mailing address:
  • Phone: 708-614-7900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number046-007652
License Number StateIL

VIII. Authorized Official

Name: DR. JAMES A VROEGH
Title or Position: PRESIDENT
Credential: OD
Phone: 708-614-7900