Provider Demographics
NPI:1124519178
Name:DR RAFFERTYS EYE ENCOUNTERS, LLC
Entity type:Organization
Organization Name:DR RAFFERTYS EYE ENCOUNTERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:RAFFERTY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:630-357-6770
Mailing Address - Street 1:29 S WEBSTER ST STE 104
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-5353
Mailing Address - Country:US
Mailing Address - Phone:630-357-6880
Mailing Address - Fax:630-357-6995
Practice Address - Street 1:29 S WEBSTER ST STE 104
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-5353
Practice Address - Country:US
Practice Address - Phone:630-357-6880
Practice Address - Fax:630-357-6995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-25
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty