Provider Demographics
NPI:1659488898
Name:DIANA F PENUELA-ONEILL PC
Entity Type:Organization
Organization Name:DIANA F PENUELA-ONEILL PC
Other - Org Name:NORTHWEST EYECARE 1
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:F
Authorized Official - Last Name:PENUELA-ONEILL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:847-658-0120
Mailing Address - Street 1:10620 TAURUS CT
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:IL
Mailing Address - Zip Code:60098-8000
Mailing Address - Country:US
Mailing Address - Phone:815-338-9936
Mailing Address - Fax:815-338-9904
Practice Address - Street 1:245 STONEGATE RD
Practice Address - Street 2:
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102-5614
Practice Address - Country:US
Practice Address - Phone:847-658-0120
Practice Address - Fax:847-658-0610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-008362152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL5029Medicare PIN
ILIL5030Medicare PIN