Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 046.010960 | IL |
N | 152W00000X | Optometrist | OPC 4469 | FL |
NPI | 1013243161 |
---|---|
Provider Name | Ms. Ann Sonia Kalladanthyil |
First Address | Woodridge, IL 60517-2308 |
Second Address | Woodridge, IL 60517-2308 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2009 |
Last Update Date | 20/09/2016 |