Healthcare Provider Details

I. General information

NPI: 1922162692
Provider Name (Legal Business Name): MARTHA T KOCHNO O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3128 PLAINFIELD RD LOUIS JOLIET MALL
JOLIET IL
60435-1194
US

IV. Provider business mailing address

5517 LAKESIDE DR APT #2E
LISLE IL
60532-2510
US

V. Phone/Fax

Practice location:
  • Phone: 815-439-3064
  • Fax:
Mailing address:
  • Phone: 630-605-4797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: