Individual
JULIAN LARA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COA
Contact information
Practice address
550 E BOUGHTON RD STE 120, BOLINGBROOK, IL 60440-2193
(630) 783-9960
Mailing address
9813 S KEELER AVE APT D, OAK LAWN, IL 60453-3474
(773) 290-4157
Taxonomy
Speciality
Code
Description
License number
State
156FX1101X
Ophthalmic Assistant
Primary
—
—
Other
Enumeration date
09/05/2017
Last updated
09/05/2017
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