Provider Demographics
NPI:1407843055
Name:VAHEY, JEAN B (MD)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:B
Last Name:VAHEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8921 N. WOOD SAGE RD.
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-7822
Mailing Address - Country:US
Mailing Address - Phone:309-243-2400
Mailing Address - Fax:309-243-7918
Practice Address - Street 1:8921 N. WOOD SAGE RD.
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-7822
Practice Address - Country:US
Practice Address - Phone:309-243-2400
Practice Address - Fax:309-243-7918
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036048216207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036084216Medicaid
F42549Medicare UPIN
3891390Medicare ID - Type Unspecified