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Organization

FOX VALLEY OPHTHALMOLOGY

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MS. SUSAN C MOSS (ADMINISTRATOR)
(630) 584-9850
Entity
Organization

Contact information

Practice address
40W330 LAFOX RD, ST CHARLES, IL 60175-6515
(630) 584-9850
(630) 584-1523
Mailing address
750 FLETCHER DR STE 106, ELGIN, IL 60123-4703
(847) 695-0499
(847) 695-4339

Taxonomy

Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
042002501
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
04519570
BCBS
IL
01
379827
UNITED HEALTHCARE
IL
01
CL1986
MEDICARE RAILROAD
IL
Enumeration date
03/03/2008
Last updated
04/23/2008
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