Provider Demographics
NPI:1871629915
Name:CULLISON, CHRISTOPHER (OD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:
Last Name:CULLISON
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 1:931 W 75TH ST
Mailing Address - Street 2:SUITE 123
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60565-1294
Mailing Address - Country:US
Mailing Address - Phone:630-357-6662
Mailing Address - Fax:630-357-6687
Practice Address - Street 1:931 W 75TH ST
Practice Address - Street 2:SUITE 123
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60565-1294
Practice Address - Country:US
Practice Address - Phone:630-357-6662
Practice Address - Fax:630-357-6687
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL46-006524152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist