Lincoln Square Optical

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

LINCOLN SQUARE OPTICAL

Practice address

2501 W Lawrence Ave
Chicago, IL 60625-2958

Phone

(773) 931-3839

NPI assigned

Oct 23, 2018

Organization subpart

No

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

Authorized official

Name

Mariam Ethezaz, ODNPI 1962996181

Title

Optometrist

Phone

(773) 931-3839

Specialties & licenses 5

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mariam Ethezaz, OD

  • Optometrist
  • Glenview, IL
  • NPI 1962996181
  Medicare reassignment NPD Authorized official
• Sara Nisar, OD

  • Optometrist
  • Glen Ellyn, IL
  • NPI 1013498278
  NPD

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

{
    "created_epoch": "1540252800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1540252800000",
    "number": "1346716768",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5232 WRIGHT TER",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600772161",
            "telephone_number": "773-931-3839"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2501 W LAWRENCE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606252958",
            "telephone_number": "773-931-3839"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LINCOLN SQUARE OPTICAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-23",
        "last_updated": "2018-10-23",
        "status": "A",
        "authorized_official_last_name": "ETHEZAZ",
        "authorized_official_first_name": "MARIAM",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "773-931-3839",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152WL0500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist, Low Vision Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152WP0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist, Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152WV0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist, Vision Therapy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lincoln Pediatric Center, PC
• Lincoln Smiles Family Dentistry
• Lincoln Square Dental Associates, LTD.
• Lincoln Square Medical Associates, LTD.
• Lincoln Square Mindful Therapy
• Lincoln Square Orthodontics
• Renetta Denise Lincoln-Stallworth, LPN
• Christy Ann Lincoln, LCPC
• Keirstin Lincoln, LPC
• Sarah T Lincoln, M.D.

• 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 23, 2018; 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.