Provider Demographics
NPI:1447396064
Name:SBLENDORIO, KATHLEEN D (OD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:D
Last Name:SBLENDORIO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14262 SELVA LANE
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-1788
Mailing Address - Country:US
Mailing Address - Phone:708-873-0943
Mailing Address - Fax:
Practice Address - Street 1:9900 S. RIDGELAND AVENUE
Practice Address - Street 2:
Practice Address - City:CHICAGO RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60415-1241
Practice Address - Country:US
Practice Address - Phone:708-422-8955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
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