Provider Demographics
NPI:1770656787
Name:SARA R. VEGH,O.D.,M.D.,S.C.
Entity Type:Organization
Organization Name:SARA R. VEGH,O.D.,M.D.,S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SARA
Authorized Official - Middle Name:REBECCA
Authorized Official - Last Name:VEGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-362-3811
Mailing Address - Street 1:1880 W WINCHESTER RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-5341
Mailing Address - Country:US
Mailing Address - Phone:847-362-3811
Mailing Address - Fax:847-362-0428
Practice Address - Street 1:1880 W WINCHESTER RD
Practice Address - Street 2:SUITE 105
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-5341
Practice Address - Country:US
Practice Address - Phone:847-362-3811
Practice Address - Fax:847-362-0428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036071818332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036071818Medicaid
IL04901134OtherBLUE CROSS BLUE SHIELD
ILDG5819OtherRAILROAD MEDICARE GROUP #
IL1770656787OtherGROUP NPI
IL04901134OtherBLUE CROSS BLUE SHIELD
IL0436470001Medicare NSC
IL209767Medicare PIN