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General NPI Number Information
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NPI Number | 1497889497
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Entity Type | Organization
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Legal Business Name | HANNA RAYKO LTD
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Dates
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Enumeration Date | 03/14/2007
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Last Update Date | 07/19/2012
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Provider Practice Location Address
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Address Line | 250 N RANDALL RD
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City | LAKE IN THE HILLS
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State | IL
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Zip | 60156-5943
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Country | US
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Telephone | 847-960-9912
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Fax |
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Provider Business Mailing Address
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Address Line | 2187 AVALON DR
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City | BUFFALO GROVE
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State | IL
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Zip | 60089-4684
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Country | US
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Telephone | 847-955-9919
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. HANNA RAYKO
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Credential | O.D.
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Telephone | 847-955-9919
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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 | 046008840
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License Number State | IL
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