Healthcare Provider Details

I. General information

NPI: 1831232495
Provider Name (Legal Business Name): AUSTIN-CLEETUS LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 11/12/2023
Certification Date: 11/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17W685 ROOSEVELT RD
OAKBROOK TERRACE IL
60181-3545
US

IV. Provider business mailing address

17W685 ROOSEVELT RD
OAKBROOK TERRACE IL
60181-3545
US

V. Phone/Fax

Practice location:
  • Phone: 630-916-8282
  • Fax: 630-916-6873
Mailing address:
  • Phone: 630-916-8282
  • Fax: 630-916-6873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: MS. JENNIFER SULLIVAN
Title or Position: OWNER
Credential:
Phone: 630-408-4604