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NPI Code Detail

MEDICARE: DR. VICTORIA KORDON O.D.

MEDICARE: DR. VICTORIA KORDON O.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist046.011012IL

General Provider Information

NPI Number : 1295184380
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. VICTORIA KORDON O.D.
Provider Business Mailing Address
First Line : 1455 N SANDBURG TER
Second Line : APT 407B
City : CHICAGO
State : IL
Zip : 60610-1566
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7250 S CICERO AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60629-5849
Country : US
Telephone Number : 708-728-0359
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/08/2016
Last Update Date : 06/08/2016

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