Individual
KATELYN WANG BULT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5408 N CLARK ST, CHICAGO, IL 60640-1210
(773) 275-2020
Mailing address
8614 WESTWOOD CENTER DR FL 9, VIENNA, VA 22182-2442
(703) 847-8899
(571) 223-6780
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046011623
IL
Other
Enumeration date
05/25/2022
Last updated
06/20/2022
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