Provider Demographics
NPI:1447266929
Name:AFRYL, GLENN E (OD)
Entity type:Individual
Prefix:
First Name:GLENN
Middle Name:E
Last Name:AFRYL
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 1:145 OGDEN AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-2323
Mailing Address - Country:US
Mailing Address - Phone:630-964-0400
Mailing Address - Fax:630-964-2211
Practice Address - Street 1:145 OGDEN AVE
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-2323
Practice Address - Country:US
Practice Address - Phone:630-964-0400
Practice Address - Fax:630-964-2211
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-007332152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL28694Medicare PIN