Chula Lerdvoratavee, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

046-007841 Issued in IL

Practice address

2075 Wiesbrook Rd
Oswego, IL 60543-8312

Phone

(630) 844-0908

Fax

(630) 844-0677

NPI assigned

Oct 26, 2005

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

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

Specialty

Optometry

Education

Illinois College of Optometry at Chicago, 1985

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Scott Eye Care LTD.Group PAC ID 8123118650, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Scott Eye Care LTD.

  • Optometrist
  • Montgomery, IL
  • NPI 1013121433
  Medicare reassignment Care Compare group Authorized official

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

{
    "created_epoch": "1130284800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1346230604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2075 WIESBROOK RD",
            "city": "OSWEGO",
            "state": "IL",
            "postal_code": "605438312",
            "telephone_number": "630-844-0908",
            "fax_number": "630-844-0677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2075 WIESBROOK RD",
            "city": "OSWEGO",
            "state": "IL",
            "postal_code": "605438312",
            "telephone_number": "630-844-0908",
            "fax_number": "630-844-0677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LERDVORATAVEE",
        "first_name": "CHULA",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-26",
        "last_updated": "2022-07-21",
        "certification_date": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152WL0500X",
            "taxonomy_group": "",
            "desc": "Optometrist, Low Vision Rehabilitation",
            "state": "IL",
            "license": "046-007841",
            "primary": false
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "IL",
            "license": "046-007841",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046-007841",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Charles S Lederman, MSW LCSW
• Ellen Marie Ledesma, MHS
• Nicole Ann Lentz, LMFT
• Dana Lepkowski, OTR/L
• Kristin Lepore, PHARM. D.
• Danielle Kristine Lewandowski, DT
• Tamiko Liburd
• Veronica Tsu Lickfelt, LCSW
• Life Advantage Chiropractic
• Lighthouse Beacon, PLLC

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.