Organization
CHARLES S KEFALAS ODPC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES S KEFALAS OD (PRESIDENT)
(773) 582-0660
Entity
Organization
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
Enumeration date
11/06/2006
Last updated
07/19/2010
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