Individual
SHINU PHILIP VARGHESE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
7516 S CASS AVE, DARIEN, IL 60561-4496
(630) 968-9440
Mailing address
7516 CASS AVE STE 12, DARIEN, IL 60561-4588
(630) 968-9440
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046009754
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
046009754
STATE LICENSE
IL
Enumeration date
03/10/2007
Last updated
01/04/2022
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