Provider Demographics
NPI:1346327764
Name:SAUL, JAMES MICHAEL (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MICHAEL
Last Name:SAUL
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 1:25 S VILLA AVE
Mailing Address - Street 2:
Mailing Address - City:VILLA PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60181-2650
Mailing Address - Country:US
Mailing Address - Phone:630-832-6783
Mailing Address - Fax:630-832-0495
Practice Address - Street 1:25 S VILLA AVE
Practice Address - Street 2:
Practice Address - City:VILLA PARK
Practice Address - State:IL
Practice Address - Zip Code:60181-2650
Practice Address - Country:US
Practice Address - Phone:630-832-6783
Practice Address - Fax:630-832-0495
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-007690152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
36-3640104OtherTAX ID
IL0298760001OtherDME
ILT38841Medicare UPIN
36-3640104OtherTAX ID