MEDICARE: DR. DUANE LOUIS FONTANA OD

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		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0001616047	OTHER	IL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1588609622
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DUANE LOUIS FONTANA OD

Provider Business Mailing Address
First Line	:	3335 N ARLINGTON HEIGHTS RD
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-1573
Country	:	US
Telephone Number	:	847-398-0800
Fax Number	:	847-398-0391

Provider Business Practice Location Address
First Line	:	3335 N ARLINGTON HEIGHTS RD
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-1573
Country	:	US
Telephone Number	:	847-398-0800
Fax Number	:	847-398-0391

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

Provider Enumeration Date	:	06/20/2006
Last Update Date	:	12/10/2007

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