Individual provider Active NPI

Kammy Lin, OD

  • Optometrist
  • Peoria, IL
National Provider Identifier
1083407951
Registry record updated May 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
PENDING Issued in IL
Practice address
8921 N Wood Sage Rd
Peoria, IL 61615-7822
Phone
(309) 243-2400
Fax
(309) 243-7918
NPI assigned
May 23, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 23, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X PENDING IL Primary

Addresses

Primary practice location

8921 N Wood Sage Rd
Peoria, IL 61615-7822

Mailing address

8921 N Wood Sage Rd
Peoria, IL 61615-7822
Phone (800) 872-4651

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250911003036 IL Practitioner - Optometry 4385147768 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern College of Optometry, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wyman Sicher Eye Associates SCGroup PAC ID 7911965801, 20 clinicians

Practice addresses (Care Compare)

8921 N Wood Sage Rd
Peoria, IL 61615-7822
Phone (309) 243-2400

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PENDINGILMDSports Medicine (Orthopaedic Surgery) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Wyman Sicher Eye Associates SC Optometrist CurrentSince Oct 1, 2025 Accepting new patients
Wyman Sicher Eye Associates SC CurrentSince Oct 1, 2025 Accepting new patients

Locations

2709 Broadway St
Pekin, IL 61554
Phone (309) 243-2400

8921 N Wood Sage Rd
Peoria, IL 61615
Phone (309) 243-2400

Organizations & group practices 2

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": "1747958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747958400000",
    "number": "1083407951",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8921 N WOOD SAGE RD",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616157822",
            "telephone_number": "800-872-4651",
            "fax_number": "309-243-7918"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8921 N WOOD SAGE RD",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616157822",
            "telephone_number": "309-243-2400",
            "fax_number": "309-243-7918"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIN",
        "first_name": "KAMMY",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-05-23",
        "last_updated": "2025-05-23",
        "certification_date": "2025-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "PENDING",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

Verify at the official NPI Registry.