Provider Demographics
NPI:1194939769
Name:VERBIC, VICTOR F (OD)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:F
Last Name:VERBIC
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 1:121 E LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-3207
Mailing Address - Country:US
Mailing Address - Phone:815-756-6388
Mailing Address - Fax:815-756-4861
Practice Address - Street 1:121 E LOCUST ST
Practice Address - Street 2:
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-3207
Practice Address - Country:US
Practice Address - Phone:815-756-6388
Practice Address - Fax:815-756-4861
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-009478152W00000X, 152WS0006X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046009478Medicaid
IL215676Medicare PIN