NPIMap

Organization Active NPI

Antioch Eye Associates OD PC

  • Optometrist
  • Antioch, IL
National Provider Identifier
1033385141
Registry record updated Dec 15, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
046007913 Issued in IL
Legal business name
ANTIOCH EYE ASSOCIATES OD PC
Practice address
884 Hillside Ave
Antioch, IL 60002-1226
Phone
(847) 395-4090
Fax
(847) 395-7378
NPI assigned
May 8, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 15, 2011

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

Authorized official

Name
Dr. Connie J Crawfrod, O.D.
Title
Owner
Phone
(847) 395-4090

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X 046007913 IL Primary
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X 046009062 IL

Addresses

Primary practice location

884 Hillside Ave
Antioch, IL 60002-1226

Mailing address

884 Hillside Ave
Antioch, IL 60002-1226
Phone (847) 395-4090

Other names 1

  • Connie J. Crawford OD, P.C. Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120103000560 IL Part B Supplier - Clinic/Group Practice 0345416939 Receives reassigned benefits from 5 practitioners
Practice locations: Antioch, IL

National Provider Directory

National Provider Directory

Locations

884 Hillside Ave
Antioch, IL 60002
Phone (847) 395-1110

31 North Ave
Antioch, IL 60002
Phone (847) 395-4090

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1210204800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1323907200000",
    "number": "1033385141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "884 HILLSIDE AVE",
            "city": "ANTIOCH",
            "state": "IL",
            "postal_code": "600021226",
            "telephone_number": "847-395-4090",
            "fax_number": "847-395-7378"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "884 HILLSIDE AVE",
            "city": "ANTIOCH",
            "state": "IL",
            "postal_code": "600021226",
            "telephone_number": "847-395-4090",
            "fax_number": "847-395-7378"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANTIOCH EYE ASSOCIATES OD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-08",
        "last_updated": "2011-12-15",
        "status": "A",
        "authorized_official_last_name": "CRAWFROD",
        "authorized_official_first_name": "CONNIE",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "847-395-4090",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046007913",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046009062",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Connie J. Crawford OD, P.C.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Antioch, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2011; 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.