Individual
DR. SAMUEL JOSEPH FORZLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1192 WALTER ST, SUITE A, LEMONT, IL 60439-2903
(630) 269-8518
Mailing address
1192 WALTER ST, SUITE A, LEMONT, IL 60439-2903
(630) 269-8518
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046-008265
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001621942
BLUE CROSS BLUE SHIELD IL
—
05
—
046-008265
—
IL
01
—
K31416
MEDICARE
—
Enumeration date
08/09/2006
Last updated
06/26/2008
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