Provider Demographics
NPI:1174682686
Name:MC ARDLE, GEORGE J (OD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:J
Last Name:MC ARDLE
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 1:1852 BAY SCOTT CIR
Mailing Address - Street 2:SUITE 112
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-1131
Mailing Address - Country:US
Mailing Address - Phone:630-355-1531
Mailing Address - Fax:
Practice Address - Street 1:1852 BAY SCOTT CIR
Practice Address - Street 2:SUITE 112
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-1131
Practice Address - Country:US
Practice Address - Phone:630-355-1531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02284073OtherBCBS
IL02284073OtherBCBS
IL717401Medicare ID - Type Unspecified