MEDICARE: DR. JOHN A RANGEL 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
1	152W00000X	Optometrist	046-008674	IL

General Provider Information

NPI Number	:	1811012206
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN A RANGEL O.D.

Provider Business Mailing Address
First Line	:	4255 W 63RD ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60629-5041
Country	:	US
Telephone Number	:	708-952-0048
Fax Number	:

Provider Business Practice Location Address
First Line	:	4255 W 63RD ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60629-5041
Country	:	US
Telephone Number	:	773-306-0981
Fax Number	:	773-306-2395

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

Provider Enumeration Date	:	03/21/2007
Last Update Date	:	06/29/2016

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Directions to “ DR. JOHN A RANGEL O.D.” Practice Location

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