Active NPI
Vladislav Souboch, OD
- Optometrist
- Oak Forest, IL
National Provider Identifier
1174404867
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 046.012029
- Practice address
- 5115 152ND St
Oak Forest, IL 60452-2357 - Phone
- (708) 645-6030
- NPI assigned
- Sep 9, 2025
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 046.012029 | IL | Primary |
Addresses
Primary practice location
5115 152ND St
Oak Forest, IL 60452-2357
Mailing address
5115 152ND St
Oak Forest, IL 60452-2357
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 046.012029 | IL | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1757376000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1757376000000",
"number": "1174404867",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5115 152ND ST",
"city": "OAK FOREST",
"state": "IL",
"postal_code": "604522357"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5115 152ND ST",
"city": "OAK FOREST",
"state": "IL",
"postal_code": "604522357",
"telephone_number": "708-645-6030"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SOUBOCH",
"first_name": "VLADISLAV",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-09-09",
"last_updated": "2025-09-09",
"certification_date": "2025-09-09",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "IL",
"license": "046.012029",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oak Forest, IL
- Veeral Sheth, M.D.
- Oyeyemi Anthony Shodiya
- Kareema Siddiqui
- Erica Sidenstick, LSW, CADC
- Ranjit Sigamony, M.D
- South Suburban Multi Specialty Group LTD
- South Suburban Obstetrics &
- Southwest Cook County Cooperative Assn for Special Education
- Christopher Ryan Speaker, APN, FNP-BC
- Christine Kathleen Stanoch, LCPC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.