Individual provider Active NPI

Steven Sun-Kyu Kim, OD

  • Optometrist
  • Lisle, IL
National Provider Identifier
1316723273
Registry record updated Mar 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
046.011791 Issued in IL
Practice address
4760 Main St
Lisle, IL 60532-1724
Phone
(630) 969-2020
NPI assigned
Sep 6, 2023
Last updated
Mar 17, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 046.011791 IL Primary

Addresses

Primary practice location

4760 Main St
Lisle, IL 60532-1724

Mailing address

3400 W Stonegate Blvd Ste 25-4135
Arlington Heights, IL 60005-1045
Phone (331) 903-2125

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
I20231107000418 IL Practitioner - Optometry 1557718939 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Rosin Optical Co IncGroup PAC ID 8022921758, 51 clinicians

Practice addresses (Care Compare)

4760 Main St
Lisle, IL 60532-1724
Phone (630) 969-2020

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
046.011791ILMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Rosin Optical Co., Inc Optometrist Current Accepting new patients
Rosin Optical Co., Inc. Optometrist CurrentSince Sep 18, 2023 Accepting new patients
Rosin Optical Co. Inc. Optometrist CurrentSince Sep 18, 2023 Accepting new patients
Comprehensive Eyecare Physicians PC Past Accepting new patients

Locations

6235 Cermak Rd
Berwyn, IL 60402
Phone (708) 749-2020

145 Ogden Ave
Downers Grove, IL 60515
Phone (630) 749-2020

4760 Main St
Lisle, IL 60532
Phone (630) 969-2020

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1693958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710633600000",
    "number": "1316723273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 W STONEGATE BLVD STE 25-4135",
            "city": "ARLINGTON HEIGHTS",
            "state": "IL",
            "postal_code": "600051045",
            "telephone_number": "331-903-2125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4760 MAIN ST",
            "city": "LISLE",
            "state": "IL",
            "postal_code": "605321724",
            "telephone_number": "630-969-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "STEVEN",
        "middle_name": "SUN-KYU",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-09-06",
        "last_updated": "2024-03-17",
        "certification_date": "2024-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046.011791",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lisle, IL

Sources for this page

Verify at the official NPI Registry.