Provider Demographics
NPI:1558358283
Name:KAJITA, STEVEN K (PC)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:K
Last Name:KAJITA
Suffix:
Gender:M
Credentials:PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 N LINCOLN AVE
Mailing Address - Street 2:SUITE D-1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-2313
Mailing Address - Country:US
Mailing Address - Phone:773-549-1516
Mailing Address - Fax:773-549-8928
Practice Address - Street 1:2525 N LINCOLN AVE
Practice Address - Street 2:SUITE D-1
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-2313
Practice Address - Country:US
Practice Address - Phone:773-549-1516
Practice Address - Fax:773-549-8928
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-27
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046008064152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL933560Medicare ID - Type UnspecifiedOPTOMETRIST
ILU06121Medicare UPIN