Individual
DR. GLENN D. KUELTZO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
13231 W 143RD ST, SUITE 101, HOMER GLEN, IL 60491-6638
(708) 301-2020
(708) 301-0884
Mailing address
13231 W 143RD ST, SUITE 101, HOMER GLEN, IL 60491-6638
(708) 301-2020
(708) 301-0884
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0039940592
BCBS OF ILLINOIS
IL
Enumeration date
08/08/2006
Last updated
08/31/2007
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