MEDICARE: JAMES GREMO OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	0465905	IL

General Provider Information

NPI Number	:	1386879237
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAMES GREMO OD

Provider Business Mailing Address
First Line	:	6023 W BELMONT AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60634-5116
Country	:	US
Telephone Number	:	773-237-5779
Fax Number	:

Provider Business Practice Location Address
First Line	:	6023 W BELMONT AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60634-5116
Country	:	US
Telephone Number	:	773-237-5779
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JAMES B. GREMO
Credential	:
Telephone Number	:	773-237-5779

Provider Enumeration Date	:	05/21/2009
Last Update Date	:	05/21/2009

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