MEDICARE: BILL M. PARK

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	046007008	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	DG2164	OTHER	IL	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4584027	OTHER	IL	BCBS PIN

General Provider Information

NPI Number	:	1295725950
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BILL M. PARK

Provider Business Mailing Address
First Line	:	9 S LINCOLNWAY
Second Line	:
City	:	NORTH AURORA
State	:	IL
Zip	:	60542-1608
Country	:	US
Telephone Number	:	630-844-2500
Fax Number	:	630-844-2599

Provider Business Practice Location Address
First Line	:	9 S LINCOLNWAY
Second Line	:
City	:	NORTH AURORA
State	:	IL
Zip	:	60542-1608
Country	:	US
Telephone Number	:	630-844-2500
Fax Number	:	630-844-2599

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BILL M PARK
Credential	:	OD
Telephone Number	:	630-844-2500

Provider Enumeration Date	:	10/25/2005
Last Update Date	:	06/25/2008

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Directions to “BILL M. PARK ” Practice Location

Language	Start Address	Practice Location

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