Healthcare Provider Details

I. General information

NPI: 1669362935
Provider Name (Legal Business Name): CAROLINE KACZOWKA DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2025
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5600 W ADDISON ST STE 102
CHICAGO IL
60634-4401
US

IV. Provider business mailing address

4701 N ORANGE AVE
NORRIDGE IL
60706-4409
US

V. Phone/Fax

Practice location:
  • Phone: 773-736-1717
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046011981
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: