Provider Demographics
NPI:1669514709
Name:KUO, CHEN-YU (OD)
Entity type:Individual
Prefix:
First Name:CHEN-YU
Middle Name:
Last Name:KUO
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 1:5201 CUMNOR RD
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-5210
Mailing Address - Country:US
Mailing Address - Phone:630-969-9668
Mailing Address - Fax:
Practice Address - Street 1:3319 RIDGE RD
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:IL
Practice Address - Zip Code:60438-3111
Practice Address - Country:US
Practice Address - Phone:708-474-1145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL47-930067152W00000X
IL046-009369152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL9369OtherEYEMED ID #
IL200858478OtherTAX ID