Basic Information
| Provider Information | |||||||||
| NPI: | 1164494993 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TORSON | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | JOHN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6233 CERMAK RD | ||||||||
| Address2: | |||||||||
| City: | BERWYN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604022317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7087492020 | ||||||||
| FaxNumber: | 7087497944 | ||||||||
| Practice Location | |||||||||
| Address1: | 698 ROOSEVELT RD | ||||||||
| Address2: | |||||||||
| City: | GLEN ELLYN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601375819 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6305452020 | ||||||||
| FaxNumber: | 7087497944 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2006 | ||||||||
| LastUpdateDate: | 09/04/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 046008271 | IL | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 046-008271 | 05 | IL | MEDICAID | 999575 | 01 | IL | LOCALITY MEDICARE | OTHER |