MEDICARE: DR. CHRISTOPHER CULLISON O.D.

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	46-006524	IL

General Provider Information

NPI Number	:	1871629915
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER CULLISON O.D.

Provider Business Mailing Address
First Line	:	931 W 75TH ST
Second Line	:	SUITE 123
City	:	NAPERVILLE
State	:	IL
Zip	:	60565-1294
Country	:	US
Telephone Number	:	630-357-6662
Fax Number	:	630-357-6687

Provider Business Practice Location Address
First Line	:	931 W 75TH ST
Second Line	:	SUITE 123
City	:	NAPERVILLE
State	:	IL
Zip	:	60565-1294
Country	:	US
Telephone Number	:	630-357-6662
Fax Number	:	630-357-6687

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/25/2007
Last Update Date	:	07/08/2007

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