Individual
RACHEL BORAM PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
219 E COLE AVE, WHEATON, IL 60187-3107
(306) 690-7115
Mailing address
219 E COLE AVE, WHEATON, IL 60187-3107
(306) 690-7115
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046010937
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
046010937
—
IL
01
—
P01665028
RAILROAD MEDICARE
IL
Enumeration date
06/17/2014
Last updated
03/30/2020
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