MEDICARE: DR. SEAN C ONEILL O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	046009017	IL

General Provider Information

NPI Number	:	1083770341
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SEAN C ONEILL O.D.

Provider Business Mailing Address
First Line	:	100 W RANDOLPH ST UPPR 104
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60601-3219
Country	:	US
Telephone Number	:	312-263-4909
Fax Number	:	312-263-4932

Provider Business Practice Location Address
First Line	:	100 W RANDOLPH ST UPPR 104
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60601-3219
Country	:	US
Telephone Number	:	312-263-4909
Fax Number	:	312-263-4932

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/29/2006
Last Update Date	:	09/08/2009

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