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General NPI Number Information
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NPI Number | 1639232465
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Entity Type | Individual
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Provider Name | MARK A HRYNEWYCZ O.D.
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Gender | Male
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 06/08/2016
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Provider Practice Location Address
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Address Line | 262 BISCAYNE ST
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City | BLOOMINGDALE
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State | IL
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Zip | 60108-3312
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Country | US
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Telephone | 773-430-6962
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Fax |
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Provider Business Mailing Address
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Address Line | 262 BISCAYNE ST
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City | BLOOMINGDALE
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State | IL
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Zip | 60108-3312
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Country | US
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Telephone | 630-539-4968
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Fax | 708-403-6499
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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 | 046-009343
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License Number State | IL
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