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General NPI Number Information
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NPI Number | 1083770341
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Entity Type | Individual
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Provider Name | SEAN C ONEILL O.D.
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Gender | Male
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Dates
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Enumeration Date | 12/29/2006
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Last Update Date | 09/08/2009
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Provider Practice Location Address
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Address Line | 100 W RANDOLPH ST UPPR 104
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City | CHICAGO
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State | IL
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Zip | 60601-3219
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Country | US
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Telephone | 312-263-4909
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Fax | 312-263-4932
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Provider Business Mailing Address
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Address Line | 100 W RANDOLPH ST UPPR 104
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City | CHICAGO
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State | IL
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Zip | 60601-3219
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Country | US
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Telephone | 312-263-4909
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Fax | 312-263-4932
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 046009017
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License Number State | IL
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