Provider Demographics
NPI:1851304539
Name:JAMES F. STRIETER, OD, PC
Entity Type:Organization
Organization Name:JAMES F. STRIETER, OD, PC
Other - Org Name:FAMILY EYE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OD, PARTNER, AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:B
Authorized Official - Last Name:HENDRICKS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:618-345-0210
Mailing Address - Street 1:724 ST. LOUIS ROAD
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62234-2032
Mailing Address - Country:US
Mailing Address - Phone:618-345-0210
Mailing Address - Fax:618-345-4770
Practice Address - Street 1:724 ST. LOUIS ROAD
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62234-2032
Practice Address - Country:US
Practice Address - Phone:618-345-0210
Practice Address - Fax:618-345-4770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-005800152W00000X
152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU05384Medicare UPIN
ILK05959Medicare ID - Type UnspecifiedDR JULIE HENDRICKS
IL208834Medicare UPIN
IL208834Medicare PIN
ILK05958Medicare ID - Type UnspecifiedDR JAMES STRIETER
ILT36040Medicare UPIN