NPIMap

Organization Active NPI

Ilyas Optical Inc.

  • Optometrist
  • Maywood, IL
National Provider Identifier
1124339387
Registry record updated Jun 23, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
046007174 Issued in IL
Legal business name
ILYAS OPTICAL INC.
Practice address
217 S 5TH Ave # B
Maywood, IL 60153-1647
Phone
(708) 345-4040
Fax
(708) 345-5534
NPI assigned
Jun 23, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2010

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

Authorized official

Name
Dr. David D Dewaard, O.D.NPI 1013086990
Title
Owner
Phone
(708) 345-4040

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 046007174 IL Primary

Addresses

Primary practice location

217 S 5TH Ave # B
Maywood, IL 60153-1647

Mailing address

217 S 5TH Ave # B
Maywood, IL 60153-1647
Phone (708) 345-4040

Other names 1

  • New Wilson Optical Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Ilyas Optical Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

217 S 5th Ave
Ste B
Maywood, IL 60153
Phone (708) 345-4040

Practitioners & affiliated clinicians

Practitioners 1

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": "1277251200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1277251200000",
    "number": "1124339387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "217 S 5TH AVE # B",
            "city": "MAYWOOD",
            "state": "IL",
            "postal_code": "601531647",
            "telephone_number": "708-345-4040",
            "fax_number": "708-345-5534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "217 S 5TH AVE # B",
            "city": "MAYWOOD",
            "state": "IL",
            "postal_code": "601531647",
            "telephone_number": "708-345-4040",
            "fax_number": "708-345-5534"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ILYAS OPTICAL INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-23",
        "last_updated": "2010-06-23",
        "status": "A",
        "authorized_official_last_name": "DEWAARD",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "708-345-4040",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046007174",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "New Wilson Optical",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Maywood, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2010; 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.