Provider Demographics
NPI:1417050311
Name:KAHLE, FREDERICK JOHN (OD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:JOHN
Last Name:KAHLE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 REGAN DR
Mailing Address - Street 2:
Mailing Address - City:EAST DUNDEE
Mailing Address - State:IL
Mailing Address - Zip Code:60118-3027
Mailing Address - Country:US
Mailing Address - Phone:847-844-6973
Mailing Address - Fax:
Practice Address - Street 1:10260 S. HARLEM AVE
Practice Address - Street 2:WAL-MART VISION CENTER
Practice Address - City:BRIDGEVIEW
Practice Address - State:IL
Practice Address - Zip Code:60455
Practice Address - Country:US
Practice Address - Phone:708-499-2988
Practice Address - Fax:708-499-3057
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU58288Medicare UPIN