Enrollment ID	State	Provider type	PAC ID	Details
O20160310001870	IL	Part B Supplier - Clinic/Group Practice	3577869965	Receives reassigned benefits from 113 practitioners This NPI is an additional NPI on the enrollment

National Provider Directory

Tax ID family: Myeyedr (38 organizations share this tax ID)

Specialties & licenses 1

NPPES NPI Registry

Specialty (taxonomy)	Code	License	State	Primary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP	152W00000X			Primary

Addresses

NPPES NPI Registry

Primary practice location

1475 N Dilleys Rd Ste 4
Gurnee, IL 60031-1709

Mailing address

8614 Westwood Center Dr FL 9
Vienna, VA 22182-2442
Phone (703) 847-8899

Other names 1

NPPES NPI Registry

MyEyeDr. Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on May 26, 2022.

{
    "created_epoch": "1617148800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1653523200000",
    "number": "1295313203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8614 WESTWOOD CENTER DR FL 9",
            "city": "VIENNA",
            "state": "VA",
            "postal_code": "221822442",
            "telephone_number": "703-847-8899",
            "fax_number": "571-223-6780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1475 N DILLEYS RD STE 4",
            "city": "GURNEE",
            "state": "IL",
            "postal_code": "600311709",
            "telephone_number": "847-856-3939",
            "fax_number": "847-855-8821"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MYEYEDR OPTOMETRY OF ILLINOIS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-31",
        "last_updated": "2022-05-26",
        "certification_date": "2022-05-26",
        "status": "A",
        "authorized_official_last_name": "DOWNES",
        "authorized_official_first_name": "SUE",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "703-847-8899"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MyEyeDr.",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MyEyeDr.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gurnee, IL

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2022; 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.