Provider Demographics
NPI:1447450887
Name:JAMES K. CUTLER O.D. & ASSOCIATES, P.C.
Entity type:Organization
Organization Name:JAMES K. CUTLER O.D. & ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:K
Authorized Official - Last Name:CUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:815-729-9143
Mailing Address - Street 1:370 HOUBOLT RD STE 102
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60431-8303
Mailing Address - Country:US
Mailing Address - Phone:815-729-9143
Mailing Address - Fax:815-729-1580
Practice Address - Street 1:370 HOUBOLT RD STE 102
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60431-8303
Practice Address - Country:US
Practice Address - Phone:815-729-9143
Practice Address - Fax:815-729-1580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046009198152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL09932266OtherBLUE CROSS BLUE SHIELD ID
IL046009198Medicaid
IL5306320001Medicare NSC
IL210081Medicare PIN
IL09932266OtherBLUE CROSS BLUE SHIELD ID