NPIMap

Organization Active NPI

Crystal Lake Optical Inc.

  • Optometrist
  • Crystal Lake, IL
National Provider Identifier
1124269030
Registry record updated Mar 23, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
CRYSTAL LAKE OPTICAL INC.
Practice address
6314 Northwest Hwy
Crystal Lake, IL 60014-7935
Phone
(815) 459-4074
Fax
(815) 459-4061
NPI assigned
Mar 23, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2009

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

Authorized official

Name
Dr. Richard Surowiak, O.D.NPI 1811040983
Title
President
Phone
(815) 459-4074

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X Primary

Addresses

Primary practice location

6314 Northwest Hwy
Crystal Lake, IL 60014-7935

Mailing address

6314 Northwest Hwy
Crystal Lake, IL 60014-7935
Phone (815) 459-4074

National Provider Directory

National Provider Directory

Locations

6314 N West Hwy
Crystal Lake, IL 60014
Phone (630) 585-6100

Practitioners & affiliated clinicians

Practitioners 3

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": "1237766400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1237766400000",
    "number": "1124269030",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6314 NORTHWEST HWY",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600147935",
            "telephone_number": "815-459-4074",
            "fax_number": "815-459-4061"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6314 NORTHWEST HWY",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600147935",
            "telephone_number": "815-459-4074",
            "fax_number": "815-459-4061"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRYSTAL LAKE OPTICAL INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-03-23",
        "last_updated": "2009-03-23",
        "status": "A",
        "authorized_official_last_name": "SUROWIAK",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "815-459-4074",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Crystal Lake, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.