Provider Demographics
NPI:1003896671
Name:CRETORS, LAURA (OD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:CRETORS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 KNOBB HILL LN
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-2597
Mailing Address - Country:US
Mailing Address - Phone:847-855-1743
Mailing Address - Fax:
Practice Address - Street 1:884 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:IL
Practice Address - Zip Code:60002-1226
Practice Address - Country:US
Practice Address - Phone:847-395-4090
Practice Address - Fax:847-395-7378
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU78972Medicare UPIN
ILL76091Medicare ID - Type Unspecified