Keller, Kaitlyn S
Keller, Kaitlyn S is an individual health care provider with primary practice located at 300 Memorial Dr , Crystal Lake IL 60014-6278. She recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as her primary health care specialty. Keller, Kaitlyn S can be contacted via phone (815) 459-7110.Contact Information
Primary practice address
300 Memorial Dr
Crystal Lake IL 60014-6278
Phone: (815) 459-7110
Fax: (815) 459-2889
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 046010544 | Illinois |
Profile Details
| NPI number | 1760744833 |
|---|---|
| LBN Legal business name | Keller, Kaitlyn S |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 13th, 2012 |
| Last updated | Feb 19th, 2024 - about 7 months ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1760744833 | NPPES |
| Illinois | MEDICAID | 0406010544 | |
| Illinois | Other | 502720063 |
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