Provider Demographics
NPI:1164227229
Name:KAREDAN, ANSLEE JOHN (OD)
Entity type:Individual
Prefix:
First Name:ANSLEE
Middle Name:JOHN
Last Name:KAREDAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ANSLEE
Other - Middle Name:P
Other - Last Name:JOHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9 W MADISON ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-4308
Mailing Address - Country:US
Mailing Address - Phone:312-624-2020
Mailing Address - Fax:
Practice Address - Street 1:9 W MADISON ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-4308
Practice Address - Country:US
Practice Address - Phone:312-624-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-13
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046.011956152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist