Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 152W00000X | Optometrist | 046-008267 | IL |
Y | 152W00000X | Optometrist | 2332 | WI |
N | 152W00000X | Optometrist | TPOP19 | FL |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 046-008267 | IL |
N | 152WP0200X | Pediatric Optomitrist | 046-008267 | IL |
N | 152WS0006X | Sports Vision | 046-008267 | IL |
N | 152WX0102X | Occupational Vision | 046-008267 | IL |
NPI | 1184847386 |
---|---|
Provider Name | Dr. Richard E. Sofinski |
First Address | Mount Prospect, IL 60056-3450 |
Second Address | Niles, IL 60714-5658 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2007 |
Last Update Date | 25/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U12969 | (02) | IL |