Provider Demographics
NPI:1982963203
Name:VROEGH FAMILY EYECARE
Entity Type:Organization
Organization Name:VROEGH FAMILY EYECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:VROEGH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:708-614-7900
Mailing Address - Street 1:17322 OAK PARK AVE
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-3404
Mailing Address - Country:US
Mailing Address - Phone:708-614-7900
Mailing Address - Fax:
Practice Address - Street 1:17322 OAK PARK AVE
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-3404
Practice Address - Country:US
Practice Address - Phone:708-614-7900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-07
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-007652332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILDT2022Medicare PIN
ILIL7616Medicare PIN