Provider Demographics
NPI:1891900668
Name:VICERE, CHRISTINE KAFKA (OD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:KAFKA
Last Name:VICERE
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 1:5315 W DEVON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-4107
Mailing Address - Country:US
Mailing Address - Phone:773-775-6555
Mailing Address - Fax:773-775-3350
Practice Address - Street 1:5315 W DEVON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-4107
Practice Address - Country:US
Practice Address - Phone:773-775-6555
Practice Address - Fax:773-775-3350
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
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
IL442259Medicare UPIN