MEDICARE: DR. NATALYA ROMANIV MD

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	207W00000X	Ophthalmology Physician	201864	LA
2	207W00000X	Ophthalmology Physician	036125187	IL

General Provider Information

NPI Number	:	1740470301
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NATALYA ROMANIV MD

Provider Business Mailing Address
First Line	:	2929 MCFARLAND RD
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61107-6809
Country	:	US
Telephone Number	:	815-654-2020
Fax Number	:

Provider Business Practice Location Address
First Line	:	2929 MCFARLAND RD
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61107-6809
Country	:	US
Telephone Number	:	815-654-2020
Fax Number	:

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

Provider Enumeration Date	:	07/30/2007
Last Update Date	:	08/05/2010

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