Provider Demographics
NPI:1487967329
Name:OLIVER-ERNST, KELLY D (OD)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:D
Last Name:OLIVER-ERNST
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 1:534 N RAND RD
Mailing Address - Street 2:
Mailing Address - City:LAKE ZURICH
Mailing Address - State:IL
Mailing Address - Zip Code:60047-3103
Mailing Address - Country:US
Mailing Address - Phone:847-550-5228
Mailing Address - Fax:847-550-5232
Practice Address - Street 1:534 N RAND RD
Practice Address - Street 2:
Practice Address - City:LAKE ZURICH
Practice Address - State:IL
Practice Address - Zip Code:60047-3103
Practice Address - Country:US
Practice Address - Phone:847-550-5228
Practice Address - Fax:847-550-5232
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-21
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046010327152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist