NPIMap

Organization Active NPI

Dekalb Optometric Associates PC

  • Optometrist
  • Dekalb, IL
National Provider Identifier
1205975752
Registry record updated Feb 22, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
046-006198 Issued in IL
Legal business name
DEKALB OPTOMETRIC ASSOCIATES PC
Practice address
121 E. Locust St.
Dekalb, IL 60115
Phone
(815) 756-6388
Fax
(815) 756-4861
NPI assigned
Feb 5, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2013

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

Authorized official

Name
Dr. Victor F. Verbic, O.D.NPI 1194939769
Title
Vice President
Phone
(815) 756-6388

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X 046-006198 IL Primary

Addresses

Primary practice location

121 E. Locust St.
Dekalb, IL 60115

Mailing address

121 E Locust St
Dekalb, IL 60115-3207
Phone (815) 756-6388

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081202000488 IL Part B Supplier - Clinic/Group Practice 7911068598 Receives reassigned benefits from 4 practitioners
Practice locations: Dekalb, IL

National Provider Directory

National Provider Directory

Locations

121 E Locust St
DeKalb, IL 60115
Phone (815) 756-6388

Practitioners & affiliated clinicians

Practitioners 4

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

NPI Registry JSON

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

{
    "created_epoch": "1170633600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1361491200000",
    "number": "1205975752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 E LOCUST ST",
            "city": "DEKALB",
            "state": "IL",
            "postal_code": "601153207",
            "telephone_number": "815-756-6388",
            "fax_number": "815-756-4861"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 E. LOCUST ST.",
            "city": "DEKALB",
            "state": "IL",
            "postal_code": "60115",
            "telephone_number": "815-756-6388",
            "fax_number": "815-756-4861"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEKALB OPTOMETRIC ASSOCIATES PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-05",
        "last_updated": "2013-02-22",
        "status": "A",
        "authorized_official_last_name": "VERBIC",
        "authorized_official_first_name": "VICTOR",
        "authorized_official_middle_name": "F.",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "815-756-6388",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046-006198",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dekalb, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 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.