Justin Timothy Kwan, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

046.011274 Issued in IL

Practice address

7225 N Caldwell Ave
Niles, IL 60714-4548

Phone

(847) 647-0707

Fax

(847) 647-1402

NPI assigned

Jul 6, 2009

Last updated

May 18, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1246838400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1558137600000",
    "number": "1063641538",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7225 N CALDWELL AVE",
            "city": "NILES",
            "state": "IL",
            "postal_code": "607144548",
            "telephone_number": "847-647-0707",
            "fax_number": "847-647-1402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7225 N CALDWELL AVE",
            "city": "NILES",
            "state": "IL",
            "postal_code": "607144548",
            "telephone_number": "847-647-0707",
            "fax_number": "847-647-1402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KWAN",
        "first_name": "JUSTIN",
        "middle_name": "TIMOTHY",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-07-06",
        "last_updated": "2019-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046.011274",
            "primary": true
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "IL",
            "license": "046.011274",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Krystyna Wagenhejm Ciesielski DDS PC
• Abraham Kuruvilla, M.D.
• Henry Kurzydlowski, M.D.
• Nichole Kussmann, MA, CCC-SLP
• Lauren Melina Kuta, PHARMD
• Chris Kyros, DDS
• L. Zingerman, D.D.S., P.C. (Niles Family Dental)
• Laboratory Corporation of America
• Yannis Spiros Lafazanos, DO
• Romeo Lagrosa, MD

• Optometrist in Niles, IL
• Providers in Niles, IL by specialty
• Optometrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2019; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.