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General NPI Number Information
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NPI Number | 1083803050
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Entity Type | Organization
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Legal Business Name | FOREMAN & STACK OD PC
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Dates
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Enumeration Date | 10/16/2007
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Last Update Date | 02/16/2011
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Provider Practice Location Address
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Address Line | 876 ROOSEVELT RD
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City | GLEN ELLYN
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State | IL
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Zip | 60137
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Country | US
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Telephone | 630-469-2418
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Fax | 630-469-4680
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Provider Business Mailing Address
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Address Line | 876 ROOSEVELT RD
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City | GLEN ELLYN
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State | IL
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Zip | 60137
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Country | US
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Telephone | 630-469-2418
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Fax | 630-469-4680
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Authorized Official
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Title or Position | OWNER OPTOMETRIST
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Name | DR. CATHERINE MARY STACK
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Credential | OD
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Telephone | 630-469-2418
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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 | 046007738
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 046007804
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License Number State | IA
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 046007804
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License Number State | IL
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