NPIMap

Organization Active NPI

Eye Q Optique at Imd, Inc.

  • Eyewear Supplier
  • Chicago, IL
National Provider Identifier
1093379877
Registry record updated Jul 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Eyewear SupplierTaxonomy code 332H00000X
Legal business name
EYE Q OPTIQUE AT IMD, INC.
Practice address
709 S. Seeley Ave.
Chicago, IL 60612
Phone
(312) 872-0201
Fax
(847) 589-1375
NPI assigned
Apr 26, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2020

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

Authorized official

Name
Ms. Narmina Guseynova
Title
President
Phone
(847) 404-7647

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X
OpticianGroup: 193200000X MULTI-SPECIALTY GROUP 156FX1800X
Eyewear Supplier 332H00000X Primary

Addresses

Primary practice location

709 S. Seeley Ave.
Chicago, IL 60612

Mailing address

722 S Buffalo Grove Rd
Buffalo Grove, IL 60089-3708
Phone (847) 404-7647

Other names 1

  • EYE Q OPTIQUE Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20191122002229 IL Part B Supplier - Clinic/Group Practice 0143652586 Receives reassigned benefits from 5 practitioners
Practice locations: Chicago, IL

National Provider Directory

National Provider Directory

Locations

709 S Seeley St
Chicago, IL 60612
Phone (312) 262-5725

Practitioners & affiliated clinicians

Practitioners 6

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": "1556236800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1594598400000",
    "number": "1093379877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "722 S BUFFALO GROVE RD",
            "city": "BUFFALO GROVE",
            "state": "IL",
            "postal_code": "600893708",
            "telephone_number": "847-404-7647",
            "fax_number": "847-589-1375"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "709 S. SEELEY AVE.",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60612",
            "telephone_number": "312-872-0201",
            "fax_number": "847-589-1375"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYE Q OPTIQUE AT IMD, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-26",
        "last_updated": "2020-07-13",
        "certification_date": "2020-07-13",
        "status": "A",
        "authorized_official_last_name": "GUSEYNOVA",
        "authorized_official_first_name": "NARMINA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "847-404-7647",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "156FX1800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Technician/Technologist, Optician",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "EYE Q OPTIQUE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2020; 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.