Individual
DR. ALBERT SIMON LICUP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
603 MADISON ST, OAK PARK, IL 60302-4437
(708) 383-2150
(708) 383-2253
Mailing address
603 MADISON ST, OAK PARK, IL 60302-4437
(708) 383-2150
(708) 383-2253
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046.009863
IL
152W00000X
Optometrist
3056-035
WI
Other
Enumeration date
07/09/2006
Last updated
05/28/2009
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