Crystal Clear Eye Care Clinic

Primary specialty

Preferred Provider OrganizationTaxonomy code 305R00000X

License

046007080 Issued in IL

Legal business name

CRYSTAL CLEAR EYE CARE CLINIC

Practice address

1760 Wise
Schaumberg, IL 60193

Phone

(847) 524-1700

Fax

(847) 524-1702

NPI assigned

Jul 27, 2009

Organization subpart

No

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

Authorized official

Name

Sherry L Bakovich

Title

Office Manger

Phone

(847) 524-1700

Specialties & licenses 2

Addresses

Other identifiers 2

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

{
    "created_epoch": "1248652800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1282780800000",
    "number": "1154552016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1760 WISE",
            "city": "SCHAUMBERG",
            "state": "IL",
            "postal_code": "60193",
            "telephone_number": "847-524-1700",
            "fax_number": "847-524-1702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1760 WISE",
            "city": "SCHAUMBERG",
            "state": "IL",
            "postal_code": "60193",
            "telephone_number": "847-524-1700",
            "fax_number": "847-524-1702"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRYSTAL CLEAR EYE CARE CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-27",
        "last_updated": "2010-08-26",
        "status": "A",
        "authorized_official_last_name": "BAKOVICH",
        "authorized_official_first_name": "SHERRY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OFFICE MANGER",
        "authorized_official_telephone_number": "847-524-1700"
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "IL",
            "license": "046007080",
            "primary": true
        },
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "IL",
            "license": "047935456",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1730125451",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1841370061",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• PMC Counseling Coaching and Consulting Services

• All providers in Schaumberg, IL
• Preferred Provider Organization in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 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.