Provider Demographics
NPI:1952463721
Name:VERGARA, FRANK LOUIS (OD)
Entity Type:Individual
Prefix:DR
First Name:FRANK
Middle Name:LOUIS
Last Name:VERGARA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:535 FAIRWAY DR
Mailing Address - Street 2:STE 127
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-3938
Mailing Address - Country:US
Mailing Address - Phone:630-428-3937
Mailing Address - Fax:630-428-8592
Practice Address - Street 1:535 FAIRWAY DR
Practice Address - Street 2:STE 127
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-3938
Practice Address - Country:US
Practice Address - Phone:630-428-3937
Practice Address - Fax:630-428-8592
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2013-02-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL046007847152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL390406Medicare ID - Type UnspecifiedPROVIDER NUMBER