Provider Demographics
NPI:1699809368
Name:SCHEITER, JUSTIN (OD)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:
Last Name:SCHEITER
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 1:2415 HOMER M ADAMS PKWY
Mailing Address - Street 2:P.O. BOX 598
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-5615
Mailing Address - Country:US
Mailing Address - Phone:618-465-1712
Mailing Address - Fax:
Practice Address - Street 1:2415 HOMER M ADAMS PKWY
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-5615
Practice Address - Country:US
Practice Address - Phone:618-465-1712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL205772Medicare ID - Type Unspecified