MEDICARE: SARA R. VEGH,O.D.,M.D.,S.C.

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	332B00000X	Durable Medical Equipment & Medical Supplies	036071818	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	DG5819	OTHER	IL	RAILROAD MEDICARE GROUP #

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	04901134	OTHER	IL	BLUE CROSS BLUE SHIELD
4	1770656787	OTHER	IL	GROUP NPI

General Provider Information

NPI Number	:	1770656787
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SARA R. VEGH,O.D.,M.D.,S.C.

Provider Business Mailing Address
First Line	:	1880 W WINCHESTER RD
Second Line	:	SUITE 105
City	:	LIBERTYVILLE
State	:	IL
Zip	:	60048-5341
Country	:	US
Telephone Number	:	847-362-3811
Fax Number	:	847-362-0428

Provider Business Practice Location Address
First Line	:	1880 W WINCHESTER RD
Second Line	:	SUITE 105
City	:	LIBERTYVILLE
State	:	IL
Zip	:	60048-5341
Country	:	US
Telephone Number	:	847-362-3811
Fax Number	:	847-362-0428

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SARA REBECCA VEGH
Credential	:	M.D.
Telephone Number	:	847-362-3811

Provider Enumeration Date	:	11/16/2006
Last Update Date	:	06/18/2013

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