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NPI Code Detail

MEDICARE: KATHRINE HOLMBERG O.D

MEDICARE: KATHRINE HOLMBERG 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
1152W00000XOptometrist046010888IL

General Provider Information

NPI Number : 1427427418
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHRINE HOLMBERG O.D
Provider Business Mailing Address
First Line : 366 DIXIE HWY
Second Line :
City : CHICAGO HEIGHTS
State : IL
Zip : 60411-1758
Country : US
Telephone Number : 708-754-0089
Fax Number :
Provider Business Practice Location Address
First Line : 366 DIXIE HWY
Second Line :
City : CHICAGO HEIGHTS
State : IL
Zip : 60411-1758
Country : US
Telephone Number : 708-754-0089
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/19/2015
Last Update Date : 09/19/2015

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Directions to “ KATHRINE HOLMBERG O.D” Practice Location

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