Active NPI
Shurouq Omari
- Optometrist
- Tinley Park, IL
National Provider Identifier
1275157125
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 046011413
- Practice address
- 16205 Harlem Ave Ste B
Tinley Park, IL 60477-1682 - Phone
- (708) 614-9301
- NPI assigned
- Jun 5, 2020
- Last updated
- Jun 5, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 046011413 | IL | Primary |
Addresses
Primary practice location
16205 Harlem Ave Ste B
Tinley Park, IL 60477-1682
Mailing address
PO Box 2460
Bridgeview, IL 60455-6460
Phone (708) 745-1907
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Optometry
- Education
- Illinois College of Optometry at Chicago, 2020
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
7248 W 80TH St
Apt 2
Bridgeview, IL 60455-1583
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 046011413 | IL | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| America's Best Contacts & Eyeglasses | Past | Accepting new patients |
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.
-
- Eyewear Supplier
- Tinley Park, IL
- NPI 1447287875
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1591315200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1591315200000",
"number": "1275157125",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2460",
"city": "BRIDGEVIEW",
"state": "IL",
"postal_code": "604556460",
"telephone_number": "708-745-1907"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16205 HARLEM AVE STE B",
"city": "TINLEY PARK",
"state": "IL",
"postal_code": "604771682",
"telephone_number": "708-614-9301"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OMARI",
"first_name": "SHUROUQ",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-06-05",
"last_updated": "2020-06-05",
"certification_date": "2020-06-05",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "IL",
"license": "046011413",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tinley Park, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- 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.