MEDICARE: KRISTINA KOINOGLOU OD

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
1	152W00000X	Optometrist	046011893	IL

General Provider Information

NPI Number	:	1346093861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTINA KOINOGLOU OD

Provider Business Mailing Address
First Line	:	360 W HUBBARD ST APT 2003
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60654-5752
Country	:	US
Telephone Number	:	330-904-1947
Fax Number	:

Provider Business Practice Location Address
First Line	:	555 S DEARBORN ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60605-1586
Country	:	US
Telephone Number	:	312-588-5999
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/08/2024
Last Update Date	:	08/20/2024

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