Provider Demographics
NPI:1194763359
Name:DELGADILLO, KATHERINE SUZANNE (OD)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:SUZANNE
Last Name:DELGADILLO
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 1:2622 W AUTUMN DR
Mailing Address - Street 2:
Mailing Address - City:ROUND LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60073-5260
Mailing Address - Country:US
Mailing Address - Phone:847-924-5751
Mailing Address - Fax:
Practice Address - Street 1:855 FEINBERG CT
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:IL
Practice Address - Zip Code:60013-2976
Practice Address - Country:US
Practice Address - Phone:847-516-3111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-009455152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL205145OtherEYEMED
IL205145OtherEYEMED