Healthcare Provider Details

I. General information

NPI: 1497662753
Provider Name (Legal Business Name): KAITLYN ANDREY OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4214 N HARLEM AVE
NORRIDGE IL
60706-1293
US

IV. Provider business mailing address

4214 N HARLEM AVE
NORRIDGE IL
60706-1293
US

V. Phone/Fax

Practice location:
  • Phone: 708-453-7005
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046012155
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: