Individual
DR. MACKENZIE KATHRYN LARGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
1101 W JACKSON BLVD, CHICAGO, IL 60607-2905
(312) 243-2446
Mailing address
555 E 4TH ST, LOCKPORT, IL 60441-3201
(708) 285-3321
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046.011618
IL
Other
Enumeration date
06/08/2022
Last updated
12/07/2023
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