Active NPI
James Michael Kelly, O.D.
- Optometrist
- Glen Ellyn, IL
National Provider Identifier
1154309524
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- OPC6854
- Practice address
- 489 Taft Ave Ste 100
Glen Ellyn, IL 60137-8209 - Phone
- (630) 790-1300
- Fax
- (630) 790-1378
- NPI assigned
- Jan 5, 2006
- Last updated
- Sep 16, 2026
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 046-008415 | IL | |
| Optometrist | 152W00000X | OPC6854 | FL | Primary |
Addresses
Primary practice location
489 Taft Ave Ste 100
Glen Ellyn, IL 60137-8209
Mailing address
489 Taft Ave Ste 100
Glen Ellyn, IL 60137-8209
Phone (630) 790-1300
Other practice location 1
9617 Gulf Research Ln
Fort Myers, FL 33912-4560
Phone (239) 418-0999
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2232411 | Other | IL | BLUE CROSS BLUE SHIELD |
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Optometry
- Education
- Indiana University - School of Optometry, 1991
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
489 Taft Ave
Suite 100
Glen Ellyn, IL 60137-8209
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 046-008415 | IL | MD | Optometrist |
Organizations & group practices 2
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1136419200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1789516800000",
"number": "1154309524",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "489 TAFT AVE STE 100",
"city": "GLEN ELLYN",
"state": "IL",
"postal_code": "601378209",
"telephone_number": "630-790-1300",
"fax_number": "630-790-1378"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "489 TAFT AVE STE 100",
"city": "GLEN ELLYN",
"state": "IL",
"postal_code": "601378209",
"telephone_number": "630-790-1300",
"fax_number": "630-790-1378"
}
],
"practiceLocations": [
{
"address_1": "9617 Gulf Research Ln",
"address_purpose": "LOCATION",
"city": "Fort Myers",
"state": "FL",
"postal_code": "339124560",
"country_code": "US",
"telephone_number": "239-418-0999",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KELLY",
"first_name": "JAMES",
"middle_name": "MICHAEL",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-05",
"last_updated": "2026-09-16",
"certification_date": "2026-09-16",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "IL",
"license": "046-008415",
"primary": false
},
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "FL",
"license": "OPC6854",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "2232411",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Glen Ellyn, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2026; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.