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NPI Code Detail

MEDICARE: DR. DARREN EUGENE KOENIG O.D.

MEDICARE: DR. DARREN EUGENE KOENIG 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
1152W00000XOptometrist5413TTX
2152W00000XOptometrist0460112373IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1467416818
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DARREN EUGENE KOENIG O.D.
Provider Business Mailing Address
First Line : 3241 S MICHIGAN AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60616-4201
Country : US
Telephone Number : 312-949-7751
Fax Number : 713-743-0963
Provider Business Practice Location Address
First Line : 3241 S MICHIGAN AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60616-4201
Country : US
Telephone Number : 312-949-7751
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/13/2006
Last Update Date : 01/10/2019

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