Provider Demographics
NPI:1215945316
Name:KAYE, LIESL ANNETTE (OD)
Entity type:Individual
Prefix:DR
First Name:LIESL
Middle Name:ANNETTE
Last Name:KAYE
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 1:5206 GREENSHIRE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:LAKE IN THE HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60156
Mailing Address - Country:US
Mailing Address - Phone:847-961-6800
Mailing Address - Fax:847-961-6064
Practice Address - Street 1:5206 GREENSHIRE CIR
Practice Address - Street 2:
Practice Address - City:LAKE IN THE HILLS
Practice Address - State:IL
Practice Address - Zip Code:60156-5893
Practice Address - Country:US
Practice Address - Phone:847-961-6800
Practice Address - Fax:847-961-6064
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-008851152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU59285Medicare UPIN
ILL94864Medicare ID - Type UnspecifiedPROVIDER NUMBER