Individual
DR. JAMES A. VITALE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1600 W LAKE ST, UNIT 106, ADDISON, IL 60101-1822
(630) 773-9410
(630) 773-9473
Mailing address
1600 W LAKE ST, UNIT 106, ADDISON, IL 60101-1822
(630) 773-9410
(630) 773-9473
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046007948
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02232964
BLUE CROSS BLUE SHIELD
IL
01
—
364078970
TAX ID
IL
Enumeration date
10/05/2006
Last updated
10/21/2008
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