MEDICARE: DR. SVETLANA KALISKER 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
1	152W00000X	Optometrist	046-008511	IL

General Provider Information

NPI Number	:	1497831143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SVETLANA KALISKER O.D.

Provider Business Mailing Address
First Line	:	217 COVENTRY CIR
Second Line	:
City	:	VERNON HILLS
State	:	IL
Zip	:	60061-1208
Country	:	US
Telephone Number	:	847-918-1130
Fax Number	:	847-918-1132

Provider Business Practice Location Address
First Line	:	2822 W DEVON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-1502
Country	:	US
Telephone Number	:	773-338-1290
Fax Number	:	847-918-1132

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

Provider Enumeration Date	:	10/27/2006
Last Update Date	:	01/16/2017

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