Provider Demographics
NPI:1154411312
Name:VROEGH, JAMES ALAN (OD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ALAN
Last Name:VROEGH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3605 SPYGLASS CIR
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-3138
Mailing Address - Country:US
Mailing Address - Phone:708-597-9778
Mailing Address - Fax:
Practice Address - Street 1:15410 S HARLEM AVE
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-4333
Practice Address - Country:US
Practice Address - Phone:708-633-0060
Practice Address - Fax:708-633-0077
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046007652152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0920080001OtherMEDICARE DME
IL0040018662OtherBCBS
IL0040018662OtherBCBS
IL410048590Medicare PIN
ILT39073Medicare UPIN
ILP01111038Medicare PIN