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General NPI Number Information
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NPI Number | 1225581184
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Entity Type | Organization
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Legal Business Name | KALLADANTHYIL EYES LTD.
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Dates
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Enumeration Date | 07/27/2016
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Last Update Date | 07/27/2016
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Provider Practice Location Address
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Address Line | 2017 75TH ST
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City | WOODRIDGE
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State | IL
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Zip | 60517-2308
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Country | US
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Telephone | 630-427-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 3096 DROVER LN
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City | DARIEN
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State | IL
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Zip | 60561-1640
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Country | US
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Telephone | 813-850-8440
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Fax |
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Authorized Official
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Title or Position | CEO/OPTOMETRIST
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Name | MRS. ANN SONIA KALLADANTHYIL
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Credential | O.D.
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Telephone | 813-850-8440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 046.010960
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License Number State | IL
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