Individual
DR. CHARLES S KEFALAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
4256 W 63RD ST, CHICAGO, IL 60629-5037
(773) 582-0660
(773) 582-0859
Mailing address
4256 W 63RD ST, CHICAGO, IL 60629-5037
(773) 582-0660
(773) 582-0859
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046008568
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
046008568
—
IL
01
—
L83487
RETIRED RAILROAD MEDICARE
IL
Enumeration date
11/06/2006
Last updated
07/09/2010
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