Active NPI
Kevin Gralak, O.D.
- Optometrist
- Joliet, IL
National Provider Identifier
1174670426
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- Practice address
- 3340 Mall Loop Dr
1532 36 Louis Joliet Mall
Joliet, IL 60431-1057 - Phone
- (815) 436-1770
- NPI assigned
- Jan 5, 2007
- Last updated
- Jul 8, 2007
- 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 | IL | Primary |
Addresses
Primary practice location
3340 Mall Loop Dr
1532 36 Louis Joliet Mall
Joliet, IL 60431-1057
Mailing address
2733 Buckingham Dr
#309
Lisle, IL 60532-4224
Phone (630) 579-4739
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 046-009597 | IL | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167955200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1174670426",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2733 BUCKINGHAM DR",
"address_2": "#309",
"city": "LISLE",
"state": "IL",
"postal_code": "605324224",
"telephone_number": "630-579-4739",
"fax_number": "815-436-1803"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3340 MALL LOOP DR",
"address_2": "1532 36 LOUIS JOLIET MALL",
"city": "JOLIET",
"state": "IL",
"postal_code": "604311057",
"telephone_number": "815-436-1770"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRALAK",
"first_name": "KEVIN",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-05",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Joliet, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.