Provider Demographics
NPI:1053436006
Name:LOGAN, CYNTHIA RAE (OD)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:RAE
Last Name:LOGAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2713 BRIARGATE CT
Mailing Address - Street 2:
Mailing Address - City:WEST CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60185-6431
Mailing Address - Country:US
Mailing Address - Phone:630-762-0274
Mailing Address - Fax:847-286-2246
Practice Address - Street 1:3333 BEVERLY RD
Practice Address - Street 2:SEARS OPTICAL
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60179-0001
Practice Address - Country:US
Practice Address - Phone:847-286-7200
Practice Address - Fax:847-286-2246
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
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