Individual provider Active NPI

Anna Katrina Pamula, OD

  • Optometrist
  • Rockford, IL
National Provider Identifier
1023728995
Registry record updated Dec 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
046.011686 Issued in IL
Practice address
1603 N Alpine Rd Ste 121
Rockford, IL 61107-1439
Phone
(815) 397-5959
NPI assigned
Dec 1, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 1, 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 046.011686 IL Primary

Addresses

Primary practice location

1603 N Alpine Rd Ste 121
Rockford, IL 61107-1439

Mailing address

8872 Jody LN Apt 2E
Des Plaines, IL 60016-7302
Phone (773) 931-0813

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
I20230203000180 IL Practitioner - Optometry 4385016260 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
046.011686ILMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Christina J. Levi O D P C Optometrist CurrentSince Dec 1, 2022 Accepting new patients
Christina J. Levi O D P C Optometrist Past Accepting new patients

Locations

111 E 4th St
Ste 440
Alton, IL 62002

2100 Troy Rd
Edwardsville, IL 62025
Phone (618) 656-8888

1603 N Alpine Rd
Ste 121
Rockford, IL 61107
Phone (815) 397-5959

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": "1669852800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1669852800000",
    "number": "1023728995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8872 JODY LN APT 2E",
            "city": "DES PLAINES",
            "state": "IL",
            "postal_code": "600167302",
            "telephone_number": "773-931-0813"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1603 N ALPINE RD STE 121",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611071439",
            "telephone_number": "815-397-5959"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAMULA",
        "first_name": "ANNA",
        "middle_name": "KATRINA",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-12-01",
        "last_updated": "2022-12-01",
        "certification_date": "2022-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046.011686",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockford, IL

Sources for this page

Verify at the official NPI Registry.