Organization
R CLIFTON CROMPTON JR & JOHN M HOLICKA PTR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CLIFTON CROMPTON JR. OD (CO-OWNER)
(773) 777-6615
Entity
Organization
Contact information
Practice address
4920 N CENTRAL AVE, CHICAGO, IL 60630-2338
(773) 777-6615
(773) 777-0177
Mailing address
4920 N CENTRAL AVE, CHICAGO, IL 60630-2338
(773) 777-6615
(773) 777-0177
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
561590
GROUP NUMBER
IL
Enumeration date
06/01/2006
Last updated
08/22/2020
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