Provider Demographics
NPI:1811012206
Name:RANGEL, JOHN A (OD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:RANGEL
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 1:4255 W 63RD ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60629-5041
Mailing Address - Country:US
Mailing Address - Phone:708-952-0048
Mailing Address - Fax:
Practice Address - Street 1:4255 W 63RD ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-5041
Practice Address - Country:US
Practice Address - Phone:773-306-0981
Practice Address - Fax:773-306-2395
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-008674152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400102116Medicare PIN