Provider Demographics
NPI:1689758047
Name:TERAJI, JAMES THOMAS (OD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:THOMAS
Last Name:TERAJI
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 1:900 SOUTH ROUTE 83
Mailing Address - Street 2:
Mailing Address - City:VILLA PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60181
Mailing Address - Country:US
Mailing Address - Phone:630-530-5303
Mailing Address - Fax:630-530-1744
Practice Address - Street 1:900 SOUTH ROUTE 83
Practice Address - Street 2:
Practice Address - City:VILLA PARK
Practice Address - State:IL
Practice Address - Zip Code:60181
Practice Address - Country:US
Practice Address - Phone:630-530-5303
Practice Address - Fax:630-530-1744
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046007746152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U66125Medicare UPIN