Provider Demographics
NPI:1831247113
Name:HUNGERFORD, TODD M (OD)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:M
Last Name:HUNGERFORD
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 1:1730 W FULLERTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-1900
Mailing Address - Country:US
Mailing Address - Phone:773-327-2022
Mailing Address - Fax:
Practice Address - Street 1:1730 W FULLERTON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-1900
Practice Address - Country:US
Practice Address - Phone:773-327-2022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046008778152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNU79890Medicare UPIN
MNL77680Medicare ID - Type Unspecified