Healthcare Provider Details

I. General information

NPI: 1073027348
Provider Name (Legal Business Name): HOLMBERG OPTOMETRIC LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2017
Last Update Date: 01/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

366 DIXIE HWY
CHICAGO HEIGHTS IL
60411-1758
US

IV. Provider business mailing address

366 DIXIE HWY
CHICAGO HEIGHTS IL
60411-1758
US

V. Phone/Fax

Practice location:
  • Phone: 708-754-0080
  • Fax: 708-754-0089
Mailing address:
  • Phone: 708-754-0080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046-010888
License Number StateIL

VIII. Authorized Official

Name: DR. KATHRINE L HOLMBERG
Title or Position: OWNER
Credential: OD
Phone: 708-754-0080