Active NPI
Forum Purnendu Dave, O.D.
- Optometrist
- Des Plaines, IL
National Provider Identifier
1043695901
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 046.010886
- Practice address
- 1070 E Oakton St
Des Plaines, IL 60018-2033 - Phone
- (847) 294-6722
- NPI assigned
- Jul 21, 2015
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 046.010886 | IL | Primary |
Addresses
Primary practice location
1070 E Oakton St
Des Plaines, IL 60018-2033
Mailing address
1070 E Oakton St
Des Plaines, IL 60018-2033
Phone (847) 294-6722
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Optometry
- Education
- Illinois College of Optometry at Chicago, 2015
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1070 E Oakton St
Des Plaines, IL 60018-2033
Phone (847) 294-6722
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 046.010886 | IL | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sam Salituro Inc | Optometrist | Current | Accepting new patients |
Locations
1070 E Oakton St
Des Plaines, IL 60018
Phone (847) 294-6722
Organizations & group practices 1
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": "1437436800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1478563200000",
"number": "1043695901",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1070 E OAKTON ST",
"city": "DES PLAINES",
"state": "IL",
"postal_code": "600182033",
"telephone_number": "847-294-6722"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1070 E OAKTON ST",
"city": "DES PLAINES",
"state": "IL",
"postal_code": "600182033",
"telephone_number": "847-294-6722"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVE",
"first_name": "FORUM",
"middle_name": "PURNENDU",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-07-21",
"last_updated": "2016-11-08",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "IL",
"license": "046.010886",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Des Plaines, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.