Keller, Kaitlyn S

Keller, Kaitlyn S is an individual health care provider with primary practice located at 300 Memorial Dr , Crystal Lake IL 60014-6278. She recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as her primary health care specialty. Keller, Kaitlyn S can be contacted via phone (815) 459-7110.

Contact Information

Primary practice address
300 Memorial Dr Crystal Lake IL 60014-6278
Phone: (815) 459-7110
Fax: (815) 459-2889
Website:
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Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X 046010544 Illinois

Profile Details

NPI number 1760744833
LBN Legal business name Keller, Kaitlyn S
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 13th, 2012
Last updated Feb 19th, 2024 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1760744833 NPPES
Illinois MEDICAID 0406010544
Illinois Other 502720063

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