Individual provider Active NPI

James Michael Kelly, O.D.

  • Optometrist
  • Glen Ellyn, IL
National Provider Identifier
1154309524
Registry record updated Sep 16, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPC6854 Issued in FL
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, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
2232411OtherILBLUE 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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20031208000583 IL Practitioner - Optometry 6406752971 Reassigns benefits to 1 organization

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
Irish Eyes LLCGroup PAC ID 2365650793, 2 clinicians

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

LicenseStateTypeSpecialty
046-008415ILMDOptometrist

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

Verify at the official NPI Registry.