Healthcare Provider Details

I. General information

NPI: 1891843587
Provider Name (Legal Business Name): EKATERINA KNOBEL-OSBORNE O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHY KNOBEL

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9450 SKOKIE BLVD
SKOKIE IL
60077-1311
US

IV. Provider business mailing address

6635 N KOSTNER AVE
LINCOLNWOOD IL
60712-3524
US

V. Phone/Fax

Practice location:
  • Phone: 847-677-7202
  • Fax:
Mailing address:
  • Phone: 312-427-3735
  • Fax: 312-427-3735

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: