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Individual

RONALD FARY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
OD

Contact information

Practice address
6601 N AVONDALE AVE STE 102, CHICAGO, IL 60631-1567
(773) 792-1011
(773) 787-1311
Mailing address
6608 KANSAS AVE, HAMMOND, IN 46323-1747
(219) 844-1684

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046009911
IL
152W00000X
Optometrist
18002261A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000306292
ANTHEM
IN
05
046009911
IL
01
1622243
BCBS OF IL
IL
05
200400220A
IN
01
410048585
RAILROAD / TRAVELERS
IN
01
P00380091
PALMETTO GBA / RR MEDICARE
IL
Enumeration date
01/13/2006
Last updated
02/23/2023
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