Provider Demographics
NPI:1760894935
Name:GRIFFITH, KAITLIN (OD)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:
Last Name:GRIFFITH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:KAITLIN
Other - Middle Name:
Other - Last Name:ALDERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:8309 N KNOXVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-2170
Mailing Address - Country:US
Mailing Address - Phone:309-693-9540
Mailing Address - Fax:309-693-9754
Practice Address - Street 1:1689 W MORTON AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:IL
Practice Address - Zip Code:62650-2717
Practice Address - Country:US
Practice Address - Phone:217-245-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-22
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046010765152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP01733864OtherRAILROAD MEDICARE
ILF400149929Medicare PIN
ILF400304383Medicare PIN
ILF400304384Medicare PIN
ILF400304382Medicare PIN
ILP01733864OtherRAILROAD MEDICARE