Provider Demographics
NPI:1831232495
Name:AUSTIN-CLEETUS LTD
Entity type:Organization
Organization Name:AUSTIN-CLEETUS LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-408-4604
Mailing Address - Street 1:17W685 ROOSEVELT RD
Mailing Address - Street 2:
Mailing Address - City:OAKBROOK TERRACE
Mailing Address - State:IL
Mailing Address - Zip Code:60181-3545
Mailing Address - Country:US
Mailing Address - Phone:630-916-8282
Mailing Address - Fax:630-916-6873
Practice Address - Street 1:17W685 ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:OAKBROOK TERRACE
Practice Address - State:IL
Practice Address - Zip Code:60181-3545
Practice Address - Country:US
Practice Address - Phone:630-916-8282
Practice Address - Fax:630-916-6873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2023-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No332H00000XSuppliersEyewear SupplierGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0824420001Medicare NSC