Healthcare Provider Details

I. General information

NPI: 1508450859
Provider Name (Legal Business Name): KRYSTYNA M KATZ OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2021
Last Update Date: 02/26/2021
Certification Date: 02/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2852 N HALSTED ST
CHICAGO IL
60657-6531
US

IV. Provider business mailing address

4831 BELMONT RD UNIT B
DOWNERS GROVE IL
60515-3242
US

V. Phone/Fax

Practice location:
  • Phone: 773-549-1111
  • Fax: 773-549-1116
Mailing address:
  • Phone: 847-567-0502
  • Fax: 773-549-1116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046011494
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: