Healthcare Provider Details

I. General information

NPI: 1104839166
Provider Name (Legal Business Name): LUDWIG CHAD KUHAR O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

932 BROOK FOREST AVE
SHOREWOOD IL
60431-8807
US

IV. Provider business mailing address

932 BROOK FOREST AVE
SHOREWOOD IL
60431-8807
US

V. Phone/Fax

Practice location:
  • Phone: 815-577-0020
  • Fax: 815-577-3884
Mailing address:
  • Phone: 815-577-0020
  • Fax: 815-577-3884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number46-009027
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: