Individual
BRENNA J KITZMANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
4600 - 30 STREET, ROCK ISLAND, IL 61201-7038
(309) 788-5524
(309) 788-9550
Mailing address
4600 - 30TH STREET, ROCK ISLAND, IL 61201-7038
(309) 788-5524
(309) 788-9550
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046010972
IL
152W00000X
Optometrist
3449
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
046010972
—
IL
Enumeration date
08/27/2015
Last updated
10/04/2017
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