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NPI Code Detail

MEDICARE: HOLMBERG OPTOMETRIC LTD

MEDICARE: HOLMBERG OPTOMETRIC LTD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist046-010888IL

General Provider Information

NPI Number : 1073027348
Entity Type Code : Organization
Provider Name (Legal Business Name) : HOLMBERG OPTOMETRIC LTD
Provider Business Mailing Address
First Line : 366 DIXIE HWY
Second Line :
City : CHICAGO HEIGHTS
State : IL
Zip : 60411-1758
Country : US
Telephone Number : 708-754-0080
Fax Number :
Provider Business Practice Location Address
First Line : 366 DIXIE HWY
Second Line :
City : CHICAGO HEIGHTS
State : IL
Zip : 60411-1758
Country : US
Telephone Number : 708-754-0080
Fax Number : 708-754-0089
Authorized Official
Title or Position : OWNER
Name : DR. KATHRINE L HOLMBERG
Credential : OD
Telephone Number : 708-754-0080
Provider Enumeration Date : 11/25/2017
Last Update Date : 01/30/2018

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Directions to “HOLMBERG OPTOMETRIC LTD ” Practice Location

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