Provider Demographics
NPI:1427196856
Name:HR OPTICAL LLC
Entity Type:Organization
Organization Name:HR OPTICAL LLC
Other - Org Name:HAUSER-ROSS OPTICAL
Other - Org Type:Other Name
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:C
Authorized Official - Last Name:RAFFERTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-756-5897
Mailing Address - Street 1:2240 GATEWAY DR
Mailing Address - Street 2:
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178-3103
Mailing Address - Country:US
Mailing Address - Phone:815-756-5897
Mailing Address - Fax:815-756-6263
Practice Address - Street 1:2240 GATEWAY DR
Practice Address - Street 2:
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-3103
Practice Address - Country:US
Practice Address - Phone:815-756-8571
Practice Address - Fax:815-756-1790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL5841920001Medicare NSC
IL214906Medicare PIN