Provider Demographics
NPI:1275758260
Name:VALENCIA M RAY MD SC
Entity Type:Organization
Organization Name:VALENCIA M RAY MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VALENCIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-251-3822
Mailing Address - Street 1:8541 S STATE ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619-5665
Mailing Address - Country:US
Mailing Address - Phone:773-873-0052
Mailing Address - Fax:773-873-0054
Practice Address - Street 1:8541 S STATE ST
Practice Address - Street 2:SUITE 5
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-5665
Practice Address - Country:US
Practice Address - Phone:773-873-0052
Practice Address - Fax:773-873-0054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL928230Medicare ID - Type Unspecified
ILE47871Medicare UPIN