Provider Demographics
NPI:1184631699
Name:FARLIK, JAMES A (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:A
Last Name:FARLIK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:IL
Mailing Address - Zip Code:61520-2530
Mailing Address - Country:US
Mailing Address - Phone:309-647-3396
Mailing Address - Fax:309-647-8119
Practice Address - Street 1:130 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:IL
Practice Address - Zip Code:61520-2530
Practice Address - Country:US
Practice Address - Phone:309-647-3396
Practice Address - Fax:309-647-8119
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046006720152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046006720Medicaid
IL0003784001OtherBCBS OF IL
ILU09332Medicare UPIN
IL0003784001OtherBCBS OF IL
IL410027488Medicare PIN
IL046006720Medicaid