Provider Demographics
NPI:1184978553
Name:JAMES A VITALE O.D., P.C.
Entity type:Organization
Organization Name:JAMES A VITALE O.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:VITALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-251-8438
Mailing Address - Street 1:1600 W LAKE ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:ADDISON
Mailing Address - State:IL
Mailing Address - Zip Code:60101-1822
Mailing Address - Country:US
Mailing Address - Phone:630-773-9410
Mailing Address - Fax:
Practice Address - Street 1:1600 W LAKE ST
Practice Address - Street 2:SUITE 106
Practice Address - City:ADDISON
Practice Address - State:IL
Practice Address - Zip Code:60101-1822
Practice Address - Country:US
Practice Address - Phone:630-773-9410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-06
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL356540Medicare PIN