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General NPI Number Information
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NPI Number | 1174610372
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Entity Type | Organization
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Legal Business Name | JULIE K. KUEKER, O.D., P.A.
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Dates
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Enumeration Date | 10/07/2006
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Last Update Date | 05/23/2008
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Provider Practice Location Address
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Address Line | 1870 W MAIN ST
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City | SALEM
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State | IL
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Zip | 62881-5838
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Country | US
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Telephone | 618-548-6590
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Fax |
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Provider Business Mailing Address
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Address Line | 11901 WESTWOOD LN
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City | HIGHLAND
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State | IL
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Zip | 62249-3863
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Country | US
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Telephone | 618-654-1704
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Fax |
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Authorized Official
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Title or Position | OWNER/OPTOMETRIST
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Name | JULIE K. KUEKER
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Credential | O.D.
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Telephone | 618-654-1704
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 046-009624
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License Number State | IL
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