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General NPI Number Information
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NPI Number | 1518154350
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Entity Type | Organization
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Legal Business Name | LAVENDER STREIFF PC
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Dates
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Enumeration Date | 09/25/2007
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Last Update Date | 04/23/2009
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Provider Practice Location Address
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Address Line | 117 W MAIN ST
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City | BENSENVILLE
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State | IL
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Zip | 60106-2133
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Country | US
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Telephone | 630-860-5066
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Fax |
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Provider Business Mailing Address
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Address Line | 117 W MAIN ST
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City | BENSENVILLE
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State | IL
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Zip | 60106-2133
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Country | US
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Telephone | 630-860-5066
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/VICE PRESIDENT/SECRETARY
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Name | DR. LAVENDER STREIFF
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Credential | O.D.
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Telephone | 847-254-9665
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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 | 046009684
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License Number State | IL
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