NPIMap

Organization Active NPI

Spectrios Institute for Low Vision

  • Low Vision Rehabilitation Optometrist
  • Wheaton, IL
National Provider Identifier
1033215447
Registry record updated Jan 23, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Low Vision Rehabilitation OptometristTaxonomy code 152WL0500X
Legal business name
SPECTRIOS INSTITUTE FOR LOW VISION
Practice address
219 E Cole Ave
Wheaton, IL 60187
Phone
(630) 690-7115
Fax
(630) 690-9037
NPI assigned
Sep 15, 2006
Last updated
Jan 23, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2015

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

Authorized official

Name
Dr. R Tracy Williams, OD
Title
Executive Director
Phone
(630) 690-7115

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Low Vision Rehabilitation OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152WL0500X Primary

Addresses

Primary practice location

219 E Cole Ave
Wheaton, IL 60187

Mailing address

219 E Cole Ave
Wheaton, IL 60187
Phone (630) 690-7115

Other identifiers 1

IdentifierTypeStateIssuer
0002221432OtherBLUE CROSS BLUE SHIELD

Other names 1

  • Deicke Center for Visual Rehabilitation Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050323000401 IL Part B Supplier - Clinic/Group Practice 1456307453 Receives reassigned benefits from 5 practitioners
Practice locations: Wheaton, IL

National Provider Directory

National Provider Directory

Locations

219 E Cole Ave
Wheaton, IL 60187
Phone (630) 690-7115

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1158278400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1421971200000",
    "number": "1033215447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "219 E COLE AVE",
            "city": "WHEATON",
            "state": "IL",
            "postal_code": "60187",
            "telephone_number": "630-690-7115",
            "fax_number": "630-690-9037"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "219 E COLE AVE",
            "city": "WHEATON",
            "state": "IL",
            "postal_code": "60187",
            "telephone_number": "630-690-7115",
            "fax_number": "630-690-9037"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPECTRIOS INSTITUTE FOR LOW VISION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-15",
        "last_updated": "2015-01-23",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "R",
        "authorized_official_middle_name": "TRACY",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "630-690-7115",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152WL0500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist, Low Vision Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "0002221432",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Deicke Center for Visual Rehabilitation",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Wheaton, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.