Matthew Degroot O.D. P.C.

Primary specialty

OptometristTaxonomy code 152W00000X

License

046-009580 Issued in IL

Legal business name

MATTHEW DEGROOT O.D. P.C.

Practice address

1430 S Ashland Ave
Chicago, IL 60608-2040

Phone

(312) 492-3615

Fax

(312) 492-3614

NPI assigned

Dec 2, 2013

Organization subpart

No

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

Authorized official

Name

Matthew Roger Degroot, O.D.NPI 1588749030

Title

Owner/President

Phone

(312) 492-3615

Specialties & licenses 1

Addresses

Other names 1

• Envision Eye Care Doing business as

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Matthew R Degroot, OD

  • Optometrist
  • Park Ridge, IL
  • NPI 1588749030
  Medicare reassignment Care Compare group Authorized official
• Melissa Degroot

  • Optometrist
  • Park Ridge, IL
  • NPI 1952437022
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1385942400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1385942400000",
    "number": "1184055154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "622 ELMDALE RD",
            "city": "GLENVIEW",
            "state": "IL",
            "postal_code": "600253902",
            "telephone_number": "847-452-7375",
            "fax_number": "312-492-3615"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1430 S ASHLAND AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606082040",
            "telephone_number": "312-492-3615",
            "fax_number": "312-492-3614"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MATTHEW DEGROOT O.D. P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-02",
        "last_updated": "2013-12-02",
        "status": "A",
        "authorized_official_last_name": "DEGROOT",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "ROGER",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "312-492-3615",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046-009580",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Envision Eye Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Emily Mattaliano, RDN
• Nancy Ann Mattei, OTR
• Matters of the Mind Counseling
• John Blair Mattes, DDS
• Matthew Boltz LCSW, PLLC
• Matthew Frantz, LCPC, LLC
• Matthew J Koscica MD PLLC
• Matthew Tunney Nutrition LLC
• Matthew Vail LCSW PLLC
• Matthew W. Gifford, O.D., P.C

• Optometrist in Chicago, IL
• Providers in Chicago, IL by specialty
• Optometrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.