Individual
DR. JIRASAN SAKULSOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
2210 N CLARK ST, CHICAGO, IL 60614-3855
(773) 697-9100
Mailing address
259 E ERIE ST, SUITE 20-220, CHICAGO, IL 60611
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046.010489
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
046010489
—
IL
Enumeration date
08/20/2007
Last updated
11/16/2022
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