Provider Demographics
NPI:1437185253
Name:KUEKER, JULIE K (OD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:K
Last Name:KUEKER
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 1:11901 WESTWOOD LN
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IL
Mailing Address - Zip Code:62249-3863
Mailing Address - Country:US
Mailing Address - Phone:618-654-1704
Mailing Address - Fax:
Practice Address - Street 1:1870 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:IL
Practice Address - Zip Code:62881-5838
Practice Address - Country:US
Practice Address - Phone:618-548-6590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-009624152W00000X
FLOPC3628152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046009624Medicaid
U88188Medicare UPIN
ILK30610Medicare PIN