Provider Demographics
NPI:1417382896
Name:WOOLDRIDGE, JAMES CHRISTOPHER (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:CHRISTOPHER
Last Name:WOOLDRIDGE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3929 N WESTERN AVE
Mailing Address - Street 2:STORE SOUTH
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-3759
Mailing Address - Country:US
Mailing Address - Phone:773-906-5725
Mailing Address - Fax:773-906-5724
Practice Address - Street 1:1005 HARLEM AVE
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-2935
Practice Address - Country:US
Practice Address - Phone:847-998-4737
Practice Address - Fax:847-998-4760
Is Sole Proprietor?:No
Enumeration Date:2013-09-04
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046010737152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP01242439OtherRAILROAD MEDICARE
ILF400095688Medicare PIN
ILP01242439OtherRAILROAD MEDICARE
ILF400095686Medicare PIN
ILF400095689Medicare PIN