Healthcare Provider Details

I. General information

NPI: 1235519190
Provider Name (Legal Business Name): NATALIE J. HUTCHISON O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2015
Last Update Date: 07/11/2022
Certification Date: 07/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 TROY RD
EDWARDSVILLE IL
62025-2595
US

IV. Provider business mailing address

111 E 4TH ST STE 440
ALTON IL
62002-6241
US

V. Phone/Fax

Practice location:
  • Phone: 618-656-8888
  • Fax:
Mailing address:
  • Phone: 618-462-9818
  • Fax: 314-741-4947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2015017826
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046010889
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: