MEDICARE: KATHLEEN AU

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	390200000X	Student in an Organized Health Care Education/Training Program
2	152W00000X	Optometrist	33786TLG	CA

General Provider Information

NPI Number	:	1871956441
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN AU

Provider Business Mailing Address
First Line	:	852 N STATE ST.
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60610
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	852 N STATE ST.
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60610
Country	:	US
Telephone Number	:	312-419-1967
Fax Number	:

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

Provider Enumeration Date	:	03/31/2016
Last Update Date	:	12/08/2025

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Directions to “ KATHLEEN AU ” Practice Location

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