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Individual

DIANE G FORECKI

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
OD

Contact information

Practice address
137 W NORTH AVE, NORTHLAKE, IL 60164-2316
(708) 409-0047
Mailing address
137 W NORTH AVE, NORTHLAKE, IL 60164-2316
(708) 409-0047

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046007557
IL

Other

Enumeration date
05/29/2008
Last updated
05/29/2008
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