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General NPI Number Information
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NPI Number | 1861877300
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Entity Type | Individual
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Provider Name | PEARL H SANTILUKKA O.D.
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Gender | Female
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Dates
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Enumeration Date | 07/27/2015
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Last Update Date | 05/02/2017
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Provider Practice Location Address
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Address Line | 3100 W IL ROUTE 60
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City | MUNDELEIN
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State | IL
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Zip | 60060-4267
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Country | US
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Telephone | 847-566-5137
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Fax | 847-566-5628
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Provider Business Mailing Address
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Address Line | 730 N MILWAUKEE AVE
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City | LIBERTYVILLE
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State | IL
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Zip | 60048-1914
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Country | US
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Telephone | 847-362-9900
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Fax |
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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 | 046010933
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License Number State | IL
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