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General NPI Number Information
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NPI Number | 1447472931
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Entity Type | Organization
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Legal Business Name | DR JURGENSEN & ASSOCIATES
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 01/03/2008
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Provider Practice Location Address
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Address Line | 905 S MAIN ST
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City | LOMBARD
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State | IL
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Zip | 60148-3347
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Country | US
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Telephone | 630-629-3030
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Fax | 630-629-1941
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Provider Business Mailing Address
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Address Line | 905 S MAIN ST
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City | LOMBARD
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State | IL
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Zip | 60148-3347
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Country | US
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Telephone | 630-629-3030
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Fax | 630-629-1941
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. SHARI RAE JURGENSEN
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Credential | OD
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Telephone | 630-629-3030
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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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