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General NPI Number Information
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NPI Number | 1326718842
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Entity Type | Individual
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Provider Name | ANDREW MORUA JR. OD
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Gender | Male
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Dates
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Enumeration Date | 09/16/2021
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Last Update Date | 09/16/2021
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Provider Practice Location Address
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Address Line | 15900 W 127TH ST STE 221B
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City | LEMONT
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State | IL
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Zip | 60439-2914
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Country | US
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Telephone | 312-888-9999
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Fax | 630-863-7854
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Provider Business Mailing Address
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Address Line | 15900 W 127TH ST STE 221B
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City | LEMONT
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State | IL
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Zip | 60439-2914
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Country | US
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Telephone | 312-888-9999
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Fax | 630-863-7854
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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 | 046011578
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License Number State | IL
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