NPIMap

Organization Active NPI

Willow Vision Health LLC

  • Optometrist
  • Chicago, IL
National Provider Identifier
1255049417
Registry record updated Nov 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
WILLOW VISION HEALTH LLC
Practice address
1439 W 103Rd St Ste 3
Chicago, IL 60643-2900
Phone
(574) 213-2003
NPI assigned
Nov 7, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2022

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

Authorized official

Name
Dr. Karina Fulton, ODNPI 1801183660
Title
Optometrist
Phone
(574) 213-2003

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 SINGLE SPECIALTY GROUP 152W00000X Primary

Addresses

Primary practice location

1439 W 103Rd St Ste 3
Chicago, IL 60643-2900

Mailing address

1439 W 103Rd St Ste 3
Chicago, IL 60643-2900
Phone (574) 213-2003

National Provider Directory

National Provider Directory

Locations

1439 W 103rd St
Ste 3
Chicago, IL 60643
Phone (574) 213-2003

Practitioners & affiliated clinicians

Practitioners 1

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": "1667779200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1668124800000",
    "number": "1255049417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1439 W 103RD ST STE 3",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606432900",
            "telephone_number": "574-213-2003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1439 W 103RD ST STE 3",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606432900",
            "telephone_number": "574-213-2003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLOW VISION HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-07",
        "last_updated": "2022-11-11",
        "certification_date": "2022-11-11",
        "status": "A",
        "authorized_official_last_name": "FULTON",
        "authorized_official_first_name": "KARINA",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "574-213-2003",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.