Individual provider Active NPI

Keith La Vallee, O.D.

  • Optometrist
  • Chicago, IL
National Provider Identifier
1023080553
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Practice address
2111 W Superior St
Chicago, IL 60612-1315
Phone
(312) 226-1020
Fax
(312) 226-0802
NPI assigned
Feb 7, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X IL Primary

Addresses

Primary practice location

2111 W Superior St
Chicago, IL 60612-1315

Mailing address

2111 W Superior St
Chicago, IL 60612-1315
Phone (312) 226-1020

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, IN2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20060428000360 IL Practitioner - Optometry 1456361898 Reassigns benefits to 1 organization
I20070613000251 IN Practitioner - Optometry 1456361898 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Illinois College of Optometry at Chicago, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

2111 W Superior St
Chicago, IL 60612-1315
Phone (312) 226-1020

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
046009075ILMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
La Vallee Optometric LTD. Optometrist CurrentSince May 1, 2006 Accepting new patients
Senior Eye Associates SC Optometrist Past Accepting new patients

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": "1139270400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1023080553",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2111 W SUPERIOR ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606121315",
            "telephone_number": "312-226-1020",
            "fax_number": "312-226-0802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2111 W SUPERIOR ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606121315",
            "telephone_number": "312-226-1020",
            "fax_number": "312-226-0802"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LA VALLEE",
        "first_name": "KEITH",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-07",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.