NPIMap

Organization Active NPI

Eyesite-Illinois Valley, L.L.C.

  • Optometrist
  • Ottawa, IL
National Provider Identifier
1245371509
Registry record updated Jan 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
46-008411 Issued in IL
Legal business name
EYESITE-ILLINOIS VALLEY, L.L.C.
Practice address
925 Clinton St
Ottawa, IL 61350-2037
Phone
(815) 434-7970
Fax
(815) 434-7950
NPI assigned
Feb 9, 2007
Last updated
Jan 20, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2021

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

Authorized official

Name
Kent Kunkel, O.D.NPI 1134272842
Title
Owner
Phone
(815) 434-7970

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
Optometrist 152W00000X 46-008411 IL Primary

Addresses

Primary practice location

925 Clinton St
Ottawa, IL 61350-2037

Mailing address

925 Clinton St
Ottawa, IL 61350-2037
Phone (815) 434-7970

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20090227000286 IL Part B Supplier - Clinic/Group Practice 4284790247 Receives reassigned benefits from 4 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Ottawa, IL; Spring Valley, IL
O20100930008465 IL DME Supplier - Physician - OptometristDME Supplier - Optician 4284790247 Practice locations: Ottawa, IL

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Eyesite-Illinois Valley LLC925 Clinton St, Ottawa, IL 61350-2037(815) 434-7970 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses|Surgical Dressings Accepts assignmentParticipating since Jan 1, 2002

National Provider Directory

National Provider Directory
Tax ID family
Eyesite-Illinois Valley LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

822 La Salle St
Ottawa, IL 61350
Phone (815) 434-7970

Practitioners & affiliated clinicians

Practitioners 9

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": "1170979200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611100800000",
    "number": "1245371509",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "925 CLINTON ST",
            "city": "OTTAWA",
            "state": "IL",
            "postal_code": "613502037",
            "telephone_number": "815-434-7970",
            "fax_number": "815-434-7950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "925 CLINTON ST",
            "city": "OTTAWA",
            "state": "IL",
            "postal_code": "613502037",
            "telephone_number": "815-434-7970",
            "fax_number": "815-434-7950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYESITE-ILLINOIS VALLEY, L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-09",
        "last_updated": "2021-01-20",
        "certification_date": "2021-01-18",
        "status": "A",
        "authorized_official_last_name": "KUNKEL",
        "authorized_official_first_name": "KENT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "815-434-7970",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "46-008411",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ottawa, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.