Provider Demographics
NPI:1043233398
Name:HUGHES, JAMES GREGORY (OD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:GREGORY
Last Name:HUGHES
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 1:14706 LA GRANGE ROAD
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-3227
Mailing Address - Country:US
Mailing Address - Phone:708-403-7895
Mailing Address - Fax:708-403-9260
Practice Address - Street 1:14706 LA GRANGE ROAD
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-3227
Practice Address - Country:US
Practice Address - Phone:708-403-7895
Practice Address - Fax:708-403-9260
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T92358Medicare UPIN
IL211773Medicare PIN
ILK18097Medicare ID - Type Unspecified