Individual
DR. KERRY M JOHN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
715 W HILLGROVE AVE, LA GRANGE, IL 60525-5964
(708) 482-3200
(708) 482-3288
Mailing address
715 W HILLGROVE AVE, LA GRANGE, IL 60525-5964
(708) 482-3200
(708) 482-3288
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046009289
IL
152WC0802X
Corneal and Contact Management Optometrist
046009289
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
046009289
—
IL
Enumeration date
08/31/2005
Last updated
12/13/2021
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