Provider Demographics
NPI:1851438048
Name:HERZBERG, CARY MARK (OD)
Entity Type:Individual
Prefix:
First Name:CARY
Middle Name:MARK
Last Name:HERZBERG
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 1:2853 E NEW YORK AVE.
Mailing Address - Street 2:SUITE B
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60502-9091
Mailing Address - Country:US
Mailing Address - Phone:630-851-3338
Mailing Address - Fax:630-851-2740
Practice Address - Street 1:2853 E NEW YORK AVE.
Practice Address - Street 2:SUITE B
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60502-9091
Practice Address - Country:US
Practice Address - Phone:630-851-3338
Practice Address - Fax:630-851-2740
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152W00000X, 152WC0802X, 152WP0200X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered152W00000XEye and Vision Services ProvidersOptometrist
Not Answered152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Not Answered152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Not Answered152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK01672Medicare ID - Type Unspecified
ILT36692Medicare UPIN