MEDICARE: JAMES F. STRIETER, OD, PC

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	046-005800	IL
2	152W00000X	Optometrist

General Provider Information

NPI Number	:	1851304539
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAMES F. STRIETER, OD, PC

Provider Business Mailing Address
First Line	:	724 ST. LOUIS ROAD
Second Line	:
City	:	COLLINSVILLE
State	:	IL
Zip	:	62234-2032
Country	:	US
Telephone Number	:	618-345-0210
Fax Number	:	618-345-4770

Provider Business Practice Location Address
First Line	:	724 ST. LOUIS ROAD
Second Line	:
City	:	COLLINSVILLE
State	:	IL
Zip	:	62234-2032
Country	:	US
Telephone Number	:	618-345-0210
Fax Number	:	618-345-4770

Authorized Official
Title or Position	:	OD, PARTNER, AUTHORIZED OFFICIAL
Name	:	JULIE B HENDRICKS
Credential	:	O.D.
Telephone Number	:	618-345-0210

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	12/11/2009

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