Active NPI
Bruce M. Portnoy, O.D.
- Optometrist
- Buffalo Grove, IL
National Provider Identifier
1104835362
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 46-006563
- Practice address
- 1133 McHenry Rd
St.108
Buffalo Grove, IL 60089-1369 - Phone
- (847) 478-9091
- Fax
- (847) 478-9095
- NPI assigned
- Aug 5, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 46-006563 | IL | Primary |
Addresses
Primary practice location
1133 McHenry Rd
St.108
Buffalo Grove, IL 60089-1369
Mailing address
1432 Gregory CT
Indian Creek, IL 60061-3229
Phone (847) 680-1674
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 46-006563 | IL | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Excel Eyecare Professionals LLC | Optometrist | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Optometrist
- Buffalo Grove, IL
- NPI 1376755371
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154736000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1104835362",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1432 GREGORY CT",
"city": "INDIAN CREEK",
"state": "IL",
"postal_code": "600613229",
"telephone_number": "847-680-1674",
"fax_number": "847-478-9095"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1133 MCHENRY RD",
"address_2": "ST.108",
"city": "BUFFALO GROVE",
"state": "IL",
"postal_code": "600891369",
"telephone_number": "847-478-9091",
"fax_number": "847-478-9095"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PORTNOY",
"first_name": "BRUCE",
"middle_name": "M.",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-05",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "IL",
"license": "46-006563",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Buffalo Grove, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.