Healthcare Provider Details

I. General information

NPI: 1457400533
Provider Name (Legal Business Name): CRYSTAL H STRICKLER O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 10/18/2022
Certification Date: 10/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2656 N ELSTON AVE
CHICAGO IL
60647-2019
US

IV. Provider business mailing address

916 KEMMAN AVE
LA GRANGE PARK IL
60526-1664
US

V. Phone/Fax

Practice location:
  • Phone: 773-862-0743
  • Fax: 773-862-0893
Mailing address:
  • Phone: 312-203-4052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046-009849
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: