Provider Demographics
NPI:1891843587
Name:KNOBEL-OSBORNE, EKATERINA (OD)
Entity Type:Individual
Prefix:
First Name:EKATERINA
Middle Name:
Last Name:KNOBEL-OSBORNE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:
Other - Last Name:KNOBEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6635 N KOSTNER AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-3524
Mailing Address - Country:US
Mailing Address - Phone:312-427-3735
Mailing Address - Fax:312-427-3735
Practice Address - Street 1:9450 SKOKIE BLVD
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-1311
Practice Address - Country:US
Practice Address - Phone:847-677-7202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
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
ILL84987Medicare ID - Type Unspecified
ILU84491Medicare UPIN