Individual provider Active NPI

Brandon Simon Lernor, O.D.

  • Optometrist
  • McHenry, IL
National Provider Identifier
1295081362
Registry record updated Jan 17, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
046010605 Issued in IL
Practice address
2050 N Richmond Rd
McHenry, IL 60051-5419
Phone
(815) 363-8555
NPI assigned
Jul 26, 2012
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 17, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 046010605 IL Primary

Addresses

Primary practice location

2050 N Richmond Rd
McHenry, IL 60051-5419

Mailing address

6643 Wheatfield St
Woodridge, IL 60517-1715
Phone (630) 408-1530

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
I20130826000493 IL Practitioner - Optometry 2163665001 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Illinois College of Optometry at Chicago, 2012
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

2050 N Richmond Rd
McHenry, IL 60051-5419
Phone (815) 363-8555

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Windy City Eye Care, Inc. Optometrist CurrentSince Aug 16, 2012 Accepting new patients

Locations

2050 N Richmond Rd
McHenry, IL 60051
Phone (815) 363-8555

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1343260800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1358380800000",
    "number": "1295081362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6643 WHEATFIELD ST",
            "city": "WOODRIDGE",
            "state": "IL",
            "postal_code": "605171715",
            "telephone_number": "630-408-1530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2050 N RICHMOND RD",
            "city": "MCHENRY",
            "state": "IL",
            "postal_code": "600515419",
            "telephone_number": "815-363-8555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LERNOR",
        "first_name": "BRANDON",
        "middle_name": "SIMON",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-07-26",
        "last_updated": "2013-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046010605",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in McHenry, IL

Sources for this page

Verify at the official NPI Registry.