Illinois Glaucoma Center, LTD

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

036 Issued in IL

Legal business name

ILLINOIS GLAUCOMA CENTER, LTD

Practice address

9980 W 190TH St
Suite D
Mokena, IL 60448-8187

Phone

(708) 429-3937

Fax

(708) 429-7020

NPI assigned

Feb 28, 2012

Last updated

Mar 14, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Lili Farrokh-Siar, M.D.NPI 1811053069

Title

Owner

Phone

(312) 949-7278

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 3

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.

• Lili Farrokh-Siar, MD

  • Ophthalmology Physician
  • Chicago, IL
  • NPI 1811053069
  Medicare reassignment NPD Authorized official
• Serge N Debustros, MD

  • Retina Specialist (Ophthalmology) Physician
  • Harvey, IL
  • NPI 1962402685
  NPD (past)
• Nancy A Tucker, M.D.

  • Ophthalmology Physician
  • Tinley Park, IL
  • NPI 1295734416
  NPD (past)

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

{
    "created_epoch": "1330387200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1489449600000",
    "number": "1265706956",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9980 W 190TH ST",
            "address_2": "SUITE D",
            "city": "MOKENA",
            "state": "IL",
            "postal_code": "604488187",
            "telephone_number": "708-429-3937",
            "fax_number": "708-429-7020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9980 W 190TH ST",
            "address_2": "SUITE D",
            "city": "MOKENA",
            "state": "IL",
            "postal_code": "604488187",
            "telephone_number": "708-429-3937",
            "fax_number": "708-429-7020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ILLINOIS GLAUCOMA CENTER, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-28",
        "last_updated": "2017-03-14",
        "status": "A",
        "authorized_official_last_name": "FARROKH-SIAR",
        "authorized_official_first_name": "LILI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "312-949-7278",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "IL",
            "license": "036",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Devon Hoster, MS, RD, LDN
• Courtney Huisenga, P.T.A
• Lauren Hurt
• Amanda Hutera
• Illinois Bone and Joint Institute LLC
• Sharyn L Ingrum, PSY.D
• Innovative Medical Consulting
• Inspire Behavioral Solutions LLC
• Instarx Pharmacy LLC
• Interstate Optical LBR Inc (marquette vision center)

• Ophthalmology Physician in Mokena, IL
• Providers in Mokena, IL by specialty
• Ophthalmology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2017; 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.