Individual
DR. JEROME CHARLES LIETZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1701 N LARKIN AVE, SUITE 105, CREST HILL, IL 60403
(815) 741-1140
(815) 741-8449
Mailing address
1701 N LARKIN AVE, SUITE 105, CREST HILL, IL 60403
(815) 741-1140
(815) 741-8449
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
IL
Other
Enumeration date
09/28/2006
Last updated
07/08/2007
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