Michael Bertucci

Primary specialty

OptometristTaxonomy code 152W00000X

License

046009720 Issued in IL

Practice address

2701 N Clark St
Chicago, IL 60614-1597

Phone

(773) 935-3762

NPI assigned

May 30, 2008

Last updated

Oct 13, 2011By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• First Impressions Optometric Associates, LLC

  • Optometrist
  • Bloomington, IN
  • NPI 1083366363
  Medicare reassignment NPD
• First Impressions Optometric Associates, LLC

  • Eyewear Supplier
  • Highland, IN
  • NPI 1942960539

  Optometrist

  NPD
• First Impressions Optometric Associates, LLC

  • Eyewear Supplier
  • Merrillville, IN
  • NPI 1003576679

  Optometrist

  NPD (past)

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

{
    "created_epoch": "1212105600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1318464000000",
    "number": "1306004809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2701 N CLARK ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606141597"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2701 N CLARK ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606141597",
            "telephone_number": "773-935-3762"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERTUCCI",
        "first_name": "MICHAEL",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-05-30",
        "last_updated": "2011-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046009720",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lakiesha Robin Bertrand
• Marcel Bertsch-Gout, MD
• Elizabeth C Bertsch, M.D.
• Marco Bertucci Zoccali, MD
• Dominique Erica Bertucci, DMD
• Nicole Bertucci
• Susan Helene Bertuglia, MSW, LCSW
• Ellysse Bertus, FNP-BC
• Melanie Rae Berube, LCSW
• Emily Kate Berwald, APN

• Optometrist in Chicago, IL
• Providers in Chicago, IL by specialty
• Optometrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2011; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.