Individual
DR. KEVIN BLACKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1730 W FULLERTON AVE, CHICAGO, IL 60614-1900
(773) 327-3000
Mailing address
1730 W FULLERTON AVE, CHICAGO, IL 60614-1900
(773) 327-3000
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046.011746
IL
Other
Enumeration date
08/11/2023
Last updated
08/11/2023
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