NPIMap

Organization Active NPI

Senior Eye Associates SC

  • Optometrist
  • Chicago, IL
National Provider Identifier
1316088305
Registry record updated Feb 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
SENIOR EYE ASSOCIATES SC
Practice address
6601 N Avondale Ave Ste 102
Chicago, IL 60631-1567
Phone
(773) 792-1011
Fax
(773) 889-0224
NPI assigned
Feb 10, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 21, 2023

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

Authorized official

Name
Ryan Christopher Barnes, O.D.NPI 1366649162
Title
President
Phone
(773) 792-1011

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X Primary

Addresses

Primary practice location

6601 N Avondale Ave Ste 102
Chicago, IL 60631-1567

Mailing address

PO Box 2354
Northbrook, IL 60065-2354
Phone (773) 792-1011

Other identifiers 1

IdentifierTypeStateIssuer
1622243OtherILBCBS IL GROUP NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040115000430 IL Part B Supplier - Clinic/Group Practice 6406757285 Receives reassigned benefits from 2 practitioners
Practice locations: Schaumburg, IL

National Provider Directory

National Provider Directory

Locations

6601 N Avondale Ave
Ste 102
Chicago, IL 60631
Phone (773) 792-1011

653 S Roselle Rd
Schaumburg, IL 60193
Phone (847) 352-5500

2030 E Algonquin Rd
Ste 404
Schaumburg, IL 60173
Phone (773) 792-1011

Practitioners & affiliated clinicians

Practitioners 20

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1171065600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1676937600000",
    "number": "1316088305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2354",
            "city": "NORTHBROOK",
            "state": "IL",
            "postal_code": "600652354",
            "telephone_number": "773-792-1011",
            "fax_number": "773-889-0224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6601 N AVONDALE AVE STE 102",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606311567",
            "telephone_number": "773-792-1011",
            "fax_number": "773-889-0224"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SENIOR EYE ASSOCIATES SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-10",
        "last_updated": "2023-02-21",
        "certification_date": "2023-02-21",
        "status": "A",
        "authorized_official_last_name": "BARNES",
        "authorized_official_first_name": "RYAN",
        "authorized_official_middle_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "773-792-1011",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS IL GROUP NUMBER",
            "identifier": "1622243",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2023; 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.