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General NPI Number Information
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NPI Number | 1134108566
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Entity Type | Individual
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Provider Name | RONALD FARY OD
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Gender | Male
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Dates
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Enumeration Date | 01/13/2006
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Last Update Date | 02/23/2023
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Provider Practice Location Address
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Address Line | 6601 N AVONDALE AVE STE 102
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City | CHICAGO
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State | IL
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Zip | 60631-1567
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Country | US
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Telephone | 773-792-1011
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Fax | 773-787-1311
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Provider Business Mailing Address
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Address Line | 6608 KANSAS AVE
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City | HAMMOND
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State | IN
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Zip | 46323-1747
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Country | US
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Telephone | 219-844-1684
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Fax |
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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 | 18002261A
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License Number State | IN
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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 | 046009911
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License Number State | IL
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