Provider Demographics
NPI:1629344247
Name:FARY, MICHAEL JOSEPH (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOSEPH
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 1:7708 S. CICERO AVENUE
Mailing Address - Street 2:SUITE A5
Mailing Address - City:BURBANK
Mailing Address - State:IL
Mailing Address - Zip Code:60459
Mailing Address - Country:US
Mailing Address - Phone:708-346-0624
Mailing Address - Fax:
Practice Address - Street 1:7708 S CICERO AVE
Practice Address - Street 2:SUITE A5
Practice Address - City:BURBANK
Practice Address - State:IL
Practice Address - Zip Code:60459
Practice Address - Country:US
Practice Address - Phone:708-346-0624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-28
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046.010408152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist