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General NPI Number Information
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NPI Number | 1124519178
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Entity Type | Organization
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Legal Business Name | DR RAFFERTYS EYE ENCOUNTERS, LLC
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Dates
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Enumeration Date | 05/25/2018
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Last Update Date | 05/25/2018
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Provider Practice Location Address
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Address Line | 29 S WEBSTER ST STE 104
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City | NAPERVILLE
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State | IL
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Zip | 60540-5353
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Country | US
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Telephone | 630-357-6880
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Fax | 630-357-6995
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Provider Business Mailing Address
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Address Line | 29 S WEBSTER ST STE 104
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City | NAPERVILLE
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State | IL
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Zip | 60540-5353
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Country | US
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Telephone | 630-357-6880
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Fax | 630-357-6995
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARK RAFFERTY
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Credential | OD
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Telephone | 630-357-6770
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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 |
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License Number State |
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