Individual
KELLY RAETHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
1475 E BELVIDERE RD STE 1297, NORTHWESTERN OPHTHALMOLOGY DEPARTMENT, GRAYSLAKE, IL 60030-2026
(847) 295-0001
Mailing address
680 N LAKE SHORE DR STE 1000, ATTN: MARTHA HOLDER, CHICAGO, IL 60611-8709
(847) 295-0001
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046-009772
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1578798989
NPI
—
Enumeration date
11/15/2006
Last updated
11/17/2015
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