Provider Demographics
NPI:1225581184
Name:KALLADANTHYIL EYES LTD.
Entity Type:Organization
Organization Name:KALLADANTHYIL EYES LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OPTOMETRIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:SONIA
Authorized Official - Last Name:KALLADANTHYIL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:813-850-8440
Mailing Address - Street 1:3096 DROVER LN
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:IL
Mailing Address - Zip Code:60561-1640
Mailing Address - Country:US
Mailing Address - Phone:813-850-8440
Mailing Address - Fax:
Practice Address - Street 1:2017 75TH ST
Practice Address - Street 2:
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-2308
Practice Address - Country:US
Practice Address - Phone:630-427-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-27
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046.010960152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty