Provider Demographics
NPI:1588609622
Name:FONTANA, DUANE LOUIS (OD)
Entity Type:Individual
Prefix:DR
First Name:DUANE
Middle Name:LOUIS
Last Name:FONTANA
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 1:3335 N ARLINGTON HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-1573
Mailing Address - Country:US
Mailing Address - Phone:847-398-0800
Mailing Address - Fax:847-398-0391
Practice Address - Street 1:3335 N ARLINGTON HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-1573
Practice Address - Country:US
Practice Address - Phone:847-398-0800
Practice Address - Fax:847-398-0391
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001616047OtherBLUE CROSS BLUE SHIELD
IL0001616047OtherBLUE CROSS BLUE SHIELD
ILT36727Medicare UPIN