Individual
RANDALL R RICKETTS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1953 N CLYBOURN AVE, CHICAGO, IL 60614-4945
(773) 857-1260
(773) 857-1624
Mailing address
1133 W PRATT BLVD, CHICAGO, IL 60626-4403
(773) 510-2769
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
047.932299
IL
Other
Enumeration date
05/21/2007
Last updated
08/14/2015
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