Provider Demographics
NPI:1114252756
Name:RANGEL & MOSQUEDA, OD PC
Entity Type:Organization
Organization Name:RANGEL & MOSQUEDA, OD PC
Other - Org Name:R & M OPTICAL
Other - Org Type:Other Name
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSQUEDA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:312-782-9316
Mailing Address - Street 1:111 N. WABASH AVE.
Mailing Address - Street 2:SUITE 1911
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-2967
Mailing Address - Country:US
Mailing Address - Phone:312-782-9316
Mailing Address - Fax:312-372-1957
Practice Address - Street 1:111 N. WABASH AVE.
Practice Address - Street 2:SUITE 1911
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-2967
Practice Address - Country:US
Practice Address - Phone:312-782-9316
Practice Address - Fax:312-372-1957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-15
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty