Panicker Optometry LLC

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

PANICKER OPTOMETRY LLC

Practice address

1300 Des Plaines Ave
Forest Park, IL 60130-2507

Phone

(708) 488-0383

NPI assigned

Feb 1, 2024

Organization subpart

No

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

Authorized official

Name

Jaison PanickerNPI 1093060097

Title

Optometrist

Phone

(630) 479-3411

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jaison Panicker, O.D.

  • Optometrist
  • Oswego, IL
  • NPI 1093060097
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1706745600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1706745600000",
    "number": "1144083296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "793 BARCLAY DR",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604406105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 DES PLAINES AVE",
            "city": "FOREST PARK",
            "state": "IL",
            "postal_code": "601302507",
            "telephone_number": "708-488-0383"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PANICKER OPTOMETRY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-01",
        "last_updated": "2024-02-01",
        "certification_date": "2024-02-01",
        "status": "A",
        "authorized_official_last_name": "PANICKER",
        "authorized_official_first_name": "JAISON",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "630-479-3411"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in Forest Park, IL
• Providers in Forest Park, IL by specialty
• Optometrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2024; 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.