NPIMap

Organization Active NPI

Annmarie Surdich-Pitra OD PC

Doing business as Optometry & Eyewear Gallery

  • Health Maintenance Organization
  • Lisle, IL
National Provider Identifier
1194055525
Registry record updated Sep 16, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Maintenance OrganizationTaxonomy code 302R00000X
License
047935871 Issued in IL
Legal business name
ANNMARIE SURDICH-PITRA OD PC
Doing business as
Optometry & Eyewear Gallery
Practice address
1712 Ogden Ave Ste D
Lisle, IL 60532-1230
Phone
(630) 541-3169
Fax
(630) 541-5140
NPI assigned
Jan 7, 2010
Last updated
Sep 16, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2010

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

Authorized official

Name
Dr. Annmarie Surdich-Pitra, OD
Title
Optometrist
Phone
(630) 541-3169

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Health Maintenance Organization 302R00000X 047935871 IL Primary

Addresses

Primary practice location

1712 Ogden Ave Ste D
Lisle, IL 60532-1230

Mailing address

1712 Ogden Ave Ste D
Lisle, IL 60532-1230
Phone (630) 541-3169

Other names 1

  • Optometry & Eyewear Gallery Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100817000756 IL Part B Supplier - Clinic/Group Practice 5597899278 Receives reassigned benefits from 2 practitioners
Practice locations: Lisle, IL

National Provider Directory

National Provider Directory

Locations

1712 Ogden Ave
Ste D
Lisle, IL 60532
Phone (630) 363-4923

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1262822400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1284595200000",
    "number": "1194055525",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1712 OGDEN AVE STE D",
            "city": "LISLE",
            "state": "IL",
            "postal_code": "605321230",
            "telephone_number": "630-541-3169",
            "fax_number": "630-541-5140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1712 OGDEN AVE STE D",
            "city": "LISLE",
            "state": "IL",
            "postal_code": "605321230",
            "telephone_number": "630-541-3169",
            "fax_number": "630-541-5140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANNMARIE SURDICH-PITRA OD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-07",
        "last_updated": "2010-09-16",
        "status": "A",
        "authorized_official_last_name": "SURDICH-PITRA",
        "authorized_official_first_name": "ANNMARIE",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "630-541-3169",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": "IL",
            "license": "047935871",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Optometry & Eyewear Gallery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lisle, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2010; 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.