Provider Demographics
NPI:1811051659
Name:CAVENDER, CATHLEEN ANN (OD)
Entity type:Individual
Prefix:
First Name:CATHLEEN
Middle Name:ANN
Last Name:CAVENDER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:CATHLEEN
Other - Middle Name:ANN
Other - Last Name:UNRUH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:526 WILLOW LN
Mailing Address - Street 2:PO BOX 733
Mailing Address - City:BEECHER
Mailing Address - State:IL
Mailing Address - Zip Code:60401
Mailing Address - Country:US
Mailing Address - Phone:708-946-2740
Mailing Address - Fax:
Practice Address - Street 1:2 RIVEROAKS DR
Practice Address - Street 2:RIVER OAKS SHOPPING CENTER
Practice Address - City:CALUMET CITY
Practice Address - State:IL
Practice Address - Zip Code:60409-1901
Practice Address - Country:US
Practice Address - Phone:708-891-7076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
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
IL315146Medicare UPIN