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NPI Code Detail

MEDICARE: CRYSTAL H STRICKLER O.D.

MEDICARE: CRYSTAL H STRICKLER O.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist046-009849IL

General Provider Information

NPI Number : 1457400533
Entity Type Code : Individual
Provider Name (Legal Business Name) : CRYSTAL H STRICKLER O.D.
Provider Business Mailing Address
First Line : 916 KEMMAN AVE
Second Line :
City : LA GRANGE PARK
State : IL
Zip : 60526-1664
Country : US
Telephone Number : 312-203-4052
Fax Number :
Provider Business Practice Location Address
First Line : 2656 N ELSTON AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60647-2019
Country : US
Telephone Number : 773-862-0743
Fax Number : 773-862-0893
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/09/2007
Last Update Date : 10/18/2022

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