Samuel Joseph Forzley, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

046-008265 Issued in IL

Practice address

1192 Walter St
Suite a
Lemont, IL 60439-2903

Phone

(630) 269-8518

NPI assigned

Aug 9, 2006

Last updated

Jun 26, 2008By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Christina J. Levi O D P C

  dba Edwardsville Vision Center

  • Optometrist
  • Edwardsville, IL
  • NPI 1477703411
  Medicare reassignment NPD
• Forzley-Colander Eye Clinic, Inc

  dba Colander-Nolan Eye Clinic

  • Optometrist
  • Worth, IL
  • NPI 1174959662
  Medicare reassignment NPD
• Forzley Eye Clinic LTD

  • Optometrist
  • Lemont, IL
  • NPI 1851301006
  Authorized official Same address or phone
• Mobile Vision of Illinois, LLC

  • Optometrist
  • Lemont, IL
  • NPI 1790099125
  Authorized official Same address or phone
• Christina J. Levi O D P C

  dba Edwardsville Vision Center

  • Optometrist
  • Edwardsville, IL
  • NPI 1033261904
  NPD (past)
• J. a. Nolan, OD LTD

  • Optometrist
  • Worth, IL
  • NPI 1992704365
  NPD (past)

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

{
    "created_epoch": "1155081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1214438400000",
    "number": "1144230392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1192 WALTER ST",
            "address_2": "SUITE A",
            "city": "LEMONT",
            "state": "IL",
            "postal_code": "604392903",
            "telephone_number": "630-269-8518"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1192 WALTER ST",
            "address_2": "SUITE A",
            "city": "LEMONT",
            "state": "IL",
            "postal_code": "604392903",
            "telephone_number": "630-269-8518"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORZLEY",
        "first_name": "SAMUEL",
        "middle_name": "JOSEPH",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-09",
        "last_updated": "2008-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046-008265",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD IL",
            "identifier": "0001621942",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "K31416",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "046-008265",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Finding Balance LTD.
• Andrea Fiore
• Alice Fitzgerald, LCPC
• Forzley Eye Clinic LTD
• Jeffrey Edward Forzley, D.C.
• Franciscan Communities Inc. II (Ancora at Mount Alverna Village)
• Franciscan Communities, Inc (Franciscan Village)
• Fresenius Medical Care Lemont, LLC (Fresenius Medical Care Lemont)
• Luke Frey
• Cheryl A Frost, LCPC

• Optometrist in Lemont, IL
• Providers in Lemont, IL by specialty
• Optometrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2008; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.