Michael William Menconi, O.D.
Individual provider Active NPI Optometrist · Sandwich, IL
NPI 1295963296 · NPPES record last updated May 31, 2011
Key facts
- NPI
- 1295963296
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 046.010227 (IL)
- Practice address
- 1112 E Railroad St
Ste 1
Sandwich, IL 60548-1894 - Phone
- (815) 786-2020
- Fax
- (815) 786-6306
- NPI assigned
- Jun 29, 2009
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20090923000242 | IL | Practitioner - Optometry | 3375699937 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 046.010227 | IL | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Visionworks, Inc | Current |
Accepting new patients | |
| Visionworks, Inc. | Optometrist | Current |
Accepting new patients |
| Karl S. Csiszer, O.D., P.C. | Optometrist | Past | Accepting new patients |
Locations
239 Golf Mill Ctr
Ste 255
Niles, IL 60714
Phone (847) 297-2286
2422 US Highway 34
Oswego, IL 60543
Phone (630) 551-4133
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 046.010227 | IL | Yes |
Addresses
Primary practice location
1112 E Railroad St
Ste 1
Sandwich, IL 60548-1894
Mailing address
1112 E Railroad St
Ste 1
Sandwich, IL 60548-1894
Phone (815) 786-2020
Other providers in Sandwich, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 31, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.