Provider Demographics
NPI:1831402130
Name:KOHN, ANDREW ERIC (OD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:ERIC
Last Name:KOHN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 S SANGAMON ST APT 108
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-3010
Mailing Address - Country:US
Mailing Address - Phone:812-219-9983
Mailing Address - Fax:773-782-1501
Practice Address - Street 1:1125 GREENLEAF AVE
Practice Address - Street 2:
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-2708
Practice Address - Country:US
Practice Address - Phone:812-219-9983
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-15
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003654A152W00000X
IL046010334152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist