Individual provider Active NPI

Vakishan Nadarajah, OD

  • Optometrist
  • Downers Grove, IL
National Provider Identifier
1215428222
Registry record updated Aug 27, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
046011307 Issued in IL
Practice address
3450 Lacey Rd
Downers Grove, IL 60515-5430
Phone
(630) 743-4500
Fax
(630) 743-4537
NPI assigned
May 24, 2018
Last updated
Aug 27, 2019By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 27, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 34008TLG CA
Optometrist 152W00000X 046011307 IL Primary

Addresses

Primary practice location

3450 Lacey Rd
Downers Grove, IL 60515-5430

Mailing address

3450 Lacey Rd
Downers Grove, IL 60515-5430
Phone (630) 743-4500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191218001492 IL Practitioner - Optometry 0042562811 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Illinois College of Optometry at Chicago, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Midwestern UniversityGroup PAC ID 6305734773, 116 clinicians

Practice addresses (Care Compare)

3450 Lacey Rd
Downers Grove, IL 60515-5430
Phone (630) 743-4500

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
34008TLGCAMDOptometrist
046011307ILMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Midwestern University Optometrist CurrentSince Nov 6, 2019 Accepting new patients
Midwestern University Multi-Specialty CurrentSince Nov 6, 2019 Accepting new patients

Locations

26520 Network Pl
Chicago, IL 60673
Phone (630) 743-4500

3450 Lacey Rd
Downers Grove, IL 60515
Phone (630) 743-4500

3450 Lacey Rd
Ste 211
Downers Grove, IL 60515
Phone (630) 743-4500

3450 Lacey Rd
Ste 602
Downers Grove, IL 60515
Phone (630) 743-4500

Interoperability endpoints

  • Direct secure messaging: vakishan.nadarajah.p1@direct.midwesternuniversity.nextgenshare.com
  • Direct secure messaging: vnadarajah18494@direct.midwestern.edu

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1527120000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566864000000",
    "number": "1215428222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3450 LACEY RD",
            "city": "DOWNERS GROVE",
            "state": "IL",
            "postal_code": "605155430",
            "telephone_number": "630-743-4500",
            "fax_number": "630-743-4537"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3450 LACEY RD",
            "city": "DOWNERS GROVE",
            "state": "IL",
            "postal_code": "605155430",
            "telephone_number": "630-743-4500",
            "fax_number": "630-743-4537"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NADARAJAH",
        "first_name": "VAKISHAN",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-05-24",
        "last_updated": "2019-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "34008TLG",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046011307",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Downers Grove, IL

Sources for this page

Verify at the official NPI Registry.