Individual
DR. GREGORY LUCIEN FENTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2015 N MAIN ST, WHEATON, IL 60187-3190
(630) 668-8250
(630) 668-8916
Mailing address
2015 N MAIN ST, WHEATON, IL 60187-3190
(630) 668-8252
(630) 668-8916
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
036124435
IL
207W00000X
Ophthalmology Physician
MT185909
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036124435
—
IL
01
—
313130004
MEDICARE
IL
Enumeration date
05/21/2007
Last updated
10/05/2022
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