Provider Demographics
NPI:1205954716
Name:SONA, ROGER ALLEN (OD)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:ALLEN
Last Name:SONA
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 1:735 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:IL
Mailing Address - Zip Code:60002-1321
Mailing Address - Country:US
Mailing Address - Phone:847-395-8885
Mailing Address - Fax:847-395-8913
Practice Address - Street 1:735 MAIN ST
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:IL
Practice Address - Zip Code:60002-1321
Practice Address - Country:US
Practice Address - Phone:847-395-8885
Practice Address - Fax:847-395-8913
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL466689152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist