Judy Chanthalangsy, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

046.011481 Issued in IL

Practice address

6560 E State St
Rockford, IL 61108-2545

Phone

(815) 997-0164

NPI assigned

Jul 18, 2012

Sex

Female

Sole proprietor

No

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.

• JC Vision Inc

  • Optometrist
  • Rockford, IL
  • NPI 1871262477

  IL, Optometrist

  Medicare reassignment NPD Authorized official

Specialty

Optometry

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Sep 24, 2021.

{
    "created_epoch": "1342569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632441600000",
    "number": "1053666818",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1592 HUNTING HOUND LN",
            "city": "BARTLETT",
            "state": "IL",
            "postal_code": "601031855",
            "telephone_number": "815-997-0164"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6560 E STATE ST",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611082545",
            "telephone_number": "815-997-0164"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHANTHALANGSY",
        "first_name": "JUDY",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-07-18",
        "last_updated": "2021-09-24",
        "certification_date": "2021-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "KY",
            "license": "1888DT",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046.011481",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000783972",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100209960",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Danielle Challenger, LPN, CNA
• Daniel F Chamberlain, MD
• Meredith Chance, LCSW
• Nisha Chandran, MD
• Changes Place
• Viengkeo Chanthaloth- Phasouk, LCSW
• Logan John Chapman-Neal
• Heather Chapman
• Charles R. Welford MD SC
• James Chatham Jr., M.D.

• All providers in Rockford, IL
• Optometrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2021; 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.

Verify at the official NPI Registry.