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General NPI Number Information
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NPI Number | 1427196856
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Entity Type | Organization
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Legal Business Name | HR OPTICAL LLC
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Dates
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Enumeration Date | 02/01/2007
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Last Update Date | 04/16/2010
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Provider Practice Location Address
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Address Line | 2240 GATEWAY DR
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City | SYCAMORE
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State | IL
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Zip | 60178-3103
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Country | US
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Telephone | 815-756-8571
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Fax | 815-756-1790
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Provider Business Mailing Address
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Address Line | 2240 GATEWAY DR
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City | SYCAMORE
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State | IL
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Zip | 60178-3103
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Country | US
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Telephone | 815-756-5897
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Fax | 815-756-6263
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. MARK C. RAFFERTY
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Credential |
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Telephone | 815-756-5897
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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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