Provider Demographics
NPI:1134108566
Name:FARY, RONALD (OD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:FARY
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 1:6608 KANSAS AVE
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:IN
Mailing Address - Zip Code:46323-1747
Mailing Address - Country:US
Mailing Address - Phone:219-844-1684
Mailing Address - Fax:
Practice Address - Street 1:6601 N AVONDALE AVE STE 102
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-1567
Practice Address - Country:US
Practice Address - Phone:773-792-1011
Practice Address - Fax:773-787-1311
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002261A152W00000X
IL046009911152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN410048585OtherRAILROAD / TRAVELERS
ILP00380091OtherPALMETTO GBA / RR MEDICARE
IL1622243OtherBCBS OF IL
IL046009911Medicaid
IN000000306292OtherANTHEM
ILP00380091OtherRAILROAD MEDICARE
IN200400220AMedicaid
IN200400220AMedicaid
IN000000306292OtherANTHEM
IL1622243OtherBCBS OF IL
IL046009911Medicaid