MEDICARE: JESSICA KATSEVMAN OD

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
1	152W00000X	Optometrist	046011777	IL

General Provider Information

NPI Number	:	1417731092
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA KATSEVMAN OD

Provider Business Mailing Address
First Line	:	2110 W ROSCOE ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-6387
Country	:	US
Telephone Number	:	773-975-2015
Fax Number	:	773-975-2476

Provider Business Practice Location Address
First Line	:	3539 N SOUTHPORT AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-6447
Country	:	US
Telephone Number	:	773-871-2020
Fax Number	:	773-871-2099

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2023
Last Update Date	:	08/23/2023

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