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General NPI Number Information
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NPI Number | 1659528016
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Entity Type | Individual
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Provider Name | MICHELLE L SANTUCCI OD
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Gender | Female
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Dates
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Enumeration Date | 08/27/2008
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Last Update Date | 03/24/2017
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Provider Practice Location Address
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Address Line | 2422 ROUTE 34
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City | OSWEGO
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State | IL
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Zip | 60543-8520
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Country | US
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Telephone | 630-551-4133
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Fax | 630-551-3794
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Provider Business Mailing Address
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Address Line | 175 E HOUSTON ST
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City | SAN ANTONIO
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State | TX
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Zip | 78205-2255
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Country | US
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Telephone | 210-524-6663
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Fax | 210-524-6587
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 046.010076
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License Number State | IL
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