Provider Demographics
NPI:1740386887
Name:COSTELLO, JAMES PATRICK (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:PATRICK
Last Name:COSTELLO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:3217 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-1069
Mailing Address - Country:US
Mailing Address - Phone:847-256-8100
Mailing Address - Fax:847-256-8102
Practice Address - Street 1:3223 LAKE AVE STE 14C
Practice Address - Street 2:
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-1069
Practice Address - Country:US
Practice Address - Phone:847-256-8100
Practice Address - Fax:847-256-8102
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2021-07-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL046007707152WC0802X, 152WP0200X, 152WS0006X, 152WV0400X, 152WX0102X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision