Provider Demographics
NPI:1689051484
Name:VARGAS, JOSE
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:
Last Name:VARGAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JOSE
Other - Middle Name:
Other - Last Name:VARGAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OPTICIAN
Mailing Address - Street 1:158 E CHICAGO ST
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60120-5524
Mailing Address - Country:US
Mailing Address - Phone:224-595-1674
Mailing Address - Fax:866-599-3488
Practice Address - Street 1:158 E CHICAGO ST
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60120-5524
Practice Address - Country:US
Practice Address - Phone:224-595-1674
Practice Address - Fax:866-599-3488
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-30
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician