Provider Demographics
NPI:1922157031
Name:SEMENTILLI, JAMES L (OD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:L
Last Name:SEMENTILLI
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 1:225 N MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-7757
Mailing Address - Country:US
Mailing Address - Phone:312-819-0206
Mailing Address - Fax:312-819-0397
Practice Address - Street 1:205 N MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-5927
Practice Address - Country:US
Practice Address - Phone:312-819-0205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
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
ILU36137Medicare UPIN
ILL77822Medicare ID - Type Unspecified