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General NPI Number Information
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NPI Number | 1629508270
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Entity Type | Individual
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Provider Name | KEVIN MICHAEL PFEIFFER O.D.
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Gender | Male
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Dates
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Enumeration Date | 06/15/2017
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Last Update Date | 06/15/2017
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Provider Practice Location Address
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Address Line | 2914 CENTRAL ST FL 1
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City | EVANSTON
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State | IL
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Zip | 60201-1237
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Country | US
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Telephone | 847-864-4768
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Fax |
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Provider Business Mailing Address
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Address Line | 41W105 OAK HILLS CT
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City | ELBURN
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State | IL
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Zip | 60119-8869
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Country | US
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Telephone | 217-799-5599
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 046.011115
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License Number State | IL
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