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General NPI Number Information
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NPI Number | 1669015723
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Entity Type | Organization
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Legal Business Name | GEORGE RIBARCHIK OD PC
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Dates
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Enumeration Date | 10/22/2019
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Last Update Date | 10/22/2019
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Provider Practice Location Address
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Address Line | 1275 LAKE AVE
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City | WOODSTOCK
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State | IL
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Zip | 60098-7415
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Country | US
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Telephone | 815-206-0998
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Fax | 815-206-3090
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Provider Business Mailing Address
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Address Line | 620 RIDGEWOOD DR
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City | CARY
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State | IL
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Zip | 60013-3216
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Country | US
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Telephone | 815-206-0998
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | GEORGE RIBARCHIK
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Credential | OD
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Telephone | 815-206-0998
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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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