Individual
JUDY CHANTHALANGSY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
6560 E STATE ST, ROCKFORD, IL 61108-2545
(815) 997-0164
Mailing address
1592 HUNTING HOUND LN, BARTLETT, IL 60103-1855
(815) 997-0164
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046.011481
IL
152W00000X
Optometrist
1888DT
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000783972
ANTHEM
KY
05
—
7100209960
—
KY
Enumeration date
07/18/2012
Last updated
09/24/2021
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