Individual
KELSEY FREDERICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2121 W DIVISION ST, CHICAGO, IL 60622-2948
(773) 669-7737
Mailing address
2121 W DIVISION ST, CHICAGO, IL 60622-2948
(773) 669-7737
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046010809
IL
Other
Enumeration date
06/12/2014
Last updated
06/12/2014
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