Kevin Harte, O.D.
Individual provider Active NPI Optometrist · Lombard, IL
NPI 1336290253 · NPPES record last updated Jan 3, 2008
Key facts
- NPI
- 1336290253
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- Practice address
- 905 S Main St
Lombard, IL 60148-3347 - Phone
- (630) 629-3030
- NPI assigned
- Jan 16, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 19
-
Shari Rae Jurgensen, O.D.
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Illinois College of Optometry at Chicago, 2001
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Shoptikal LLC
Practice addresses (Care Compare)
2101 Sycamore Rd
Dekalb, IL 60115-2045
Phone (815) 766-3516
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 |
|---|---|---|---|---|
| I20050606000869 | IL | Practitioner - Optometry | 8325081813 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 046-009384 | IL | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Shoptikal LLC | Optometrist | Current |
Accepting new patients |
| Shoptikal LLC | Optometrist | Current |
Accepting new patients |
| Shoptikal LLC | Optometrist | Current | Accepting new patients |
| Mink Resources, LTD. | Optometrist | Past | Accepting new patients |
| Dr Jurgensen & Associates | Optometrist | Past | Accepting new patients |
| Third Street Eyecare, LTD | Optometrist | Past |
Accepting new patients |
| Seven Bridges Eye Care LLC | Optometrist | Past |
Accepting new patients |
Locations
1918 Gateway Center Dr
Belvidere, IL 61008
Phone (815) 547-3456
2101 Sycamore Rd
DeKalb, IL 60115
Phone (815) 766-3516
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | IL | Yes |
Addresses
Primary practice location
905 S Main St
Lombard, IL 60148-3347
Mailing address
905 S Main St
Lombard, IL 60148-3347
Phone (630) 629-3030
NPI Registry JSON
{
"created_epoch": "1168905600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1199318400000",
"number": "1336290253",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "905 S MAIN ST",
"city": "LOMBARD",
"state": "IL",
"postal_code": "601483347",
"telephone_number": "630-629-3030"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "905 S MAIN ST",
"city": "LOMBARD",
"state": "IL",
"postal_code": "601483347",
"telephone_number": "630-629-3030"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HARTE",
"first_name": "KEVIN",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-16",
"last_updated": "2008-01-03",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lombard, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 3, 2008. 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).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.