Individual provider Active NPI

Aneta Anna Stoch, OD

  • Optometrist
  • Chicago, IL
National Provider Identifier
1003528167
Registry record updated Dec 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
046011703 Issued in IL
Practice address
3457 W 111TH St
Chicago, IL 60655-3335
Phone
(773) 253-2175
NPI assigned
Dec 20, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 046011703 IL Primary

Addresses

Primary practice location

3457 W 111TH St
Chicago, IL 60655-3335

Mailing address

PO Box 39
Lake Zurich, IL 60047-0039

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240506000296 IL Order and Referring Only - OptometryPractitioner - Optometry 4789024969

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
046011703ILMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Rasa Tamulavichus OD PC Optometrist CurrentSince Dec 28, 2022 Accepting new patients
Easy Optical Eye Care Inc. Optometrist PastSince Dec 28, 2022 Accepting new patients

Locations

3457 W 111th St
Chicago, IL 60655
Phone (773) 253-2175

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1671494400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671494400000",
    "number": "1003528167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 39",
            "city": "LAKE ZURICH",
            "state": "IL",
            "postal_code": "600470039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3457 W 111TH ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606553335",
            "telephone_number": "773-253-2175"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STOCH",
        "first_name": "ANETA",
        "middle_name": "ANNA",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-12-20",
        "last_updated": "2022-12-20",
        "certification_date": "2022-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046011703",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.