Provider Demographics
NPI:1386799229
Name:KESKITALO, JEAN E (OD)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:E
Last Name:KESKITALO
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 1:1315 GREEN PHEASANT LN
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:IL
Mailing Address - Zip Code:60510-3081
Mailing Address - Country:US
Mailing Address - Phone:630-879-6304
Mailing Address - Fax:630-378-2020
Practice Address - Street 1:1112 W BOUGHTON RD
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-1508
Practice Address - Country:US
Practice Address - Phone:630-378-2020
Practice Address - Fax:630-378-9771
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-0007928152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist