Active NPI
Samantha A Dodda, OD
- Optometrist
- Chicago, IL
National Provider Identifier
1104443720
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 046011752
- Practice address
- 3241 S Michigan Ave
Chicago, IL 60616 - Phone
- (312) 225-6200
- Fax
- (312) 949-7617
- NPI assigned
- Jun 30, 2020
- Last updated
- Aug 17, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 046011752 | IL | Primary |
| Optometrist | 152W00000X | 34826 | CA |
Addresses
Primary practice location
3241 S Michigan Ave
Chicago, IL 60616
Mailing address
744 E 3Rd St
Bloomington, IN 47405-3603
Phone (812) 855-8436
Other practice location 1
2080 Century Park E Ste 911
Los Angeles, CA 90067-2012
Phone (310) 229-1220
Other practice location 2
744 E 3rd St
Bloomington, IN 47405-3603
Phone (812) 855-8436
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IN, IL, WI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 3
Care Compare profile
Medicare Care Compare- Specialty
- Optometry
- Education
- Illinois College of Optometry at Chicago, 2020
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
3241 S Michigan Ave
Chicago, IL 60616-3878
Phone (312) 949-7751
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 34826 | CA | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Indiana University | Optometrist | Current | Accepting new patients |
| Illinois College of Optometry | Optometrist | Current | Accepting new patients |
| Shoptikal LLC | Optometrist | Current | Accepting new patients |
| Indiana University | Optometrist | Current | Accepting new patients |
| Shoptikal LLC | Optometrist | Current | Accepting new patients |
| Indiana University | Current | Accepting new patients | |
| Shoptikal LLC | Optometrist | Current | Accepting new patients |
| Shoptikal LLC | Optometrist | Past | Accepting new patients |
Locations
3241 S Michigan Ave
Chicago, IL 60616
Phone (312) 225-6200
744 E 3rd St
Bloomington, IN 47405
Phone (812) 855-8436
800 E Atwater Ave
#263
Bloomington, IN 47405
6000 Monona Dr
Ste 101
Monona, WI 53716
Phone (608) 222-9420
Interoperability endpoints
- https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
- samantha.dodda.iei@direct.ico.nextgenshare.com
Organizations & group practices 8
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Fielmann Vision Care 4313
- Eyewear Supplier
- Rockford, IL
- NPI 1467311142
Optometrist
-
dba Indiana University School of Dentistry
- General Practice Dentistry
- Indianapolis, IN
- NPI 1689790552
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1593475200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1692230400000",
"number": "1104443720",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "744 E 3RD ST",
"city": "BLOOMINGTON",
"state": "IN",
"postal_code": "474053603",
"telephone_number": "812-855-8436"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3241 S MICHIGAN AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "60616",
"telephone_number": "312-225-6200",
"fax_number": "312-949-7617"
}
],
"practiceLocations": [
{
"address_1": "2080 Century Park E Ste 911",
"address_purpose": "LOCATION",
"city": "Los Angeles",
"state": "CA",
"postal_code": "900672012",
"country_code": "US",
"telephone_number": "310-229-1220",
"fax_number": "310-229-1222",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "744 E 3rd St",
"address_purpose": "LOCATION",
"city": "Bloomington",
"state": "IN",
"postal_code": "474053603",
"country_code": "US",
"telephone_number": "812-855-8436",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "DODDA",
"first_name": "SAMANTHA",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-06-30",
"last_updated": "2023-08-17",
"certification_date": "2023-08-15",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "IL",
"license": "046011752",
"primary": true
},
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "34826",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}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 Aug 17, 2023; 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.