Active NPI
Renuka Sivanesan, O.D.
- Optometrist
- Calumet City, IL
National Provider Identifier
1356572986
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 046010288
- Practice address
- 2060 River Oaks Dr
Calumet City, IL 60409-5074 - Phone
- (708) 891-2004
- NPI assigned
- Jul 30, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 046010288 | IL | Primary |
Addresses
Primary practice location
2060 River Oaks Dr
Calumet City, IL 60409-5074
Mailing address
2060 River Oaks Dr
Calumet City, IL 60409-5074
Phone (708) 891-2004
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 046010288 | IL | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Consolidated Vision Group, Inc. | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Eyewear Supplier
- Calumet City, IL
- NPI 1265464051
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1248912000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1248912000000",
"number": "1356572986",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2060 RIVER OAKS DR",
"city": "CALUMET CITY",
"state": "IL",
"postal_code": "604095074",
"telephone_number": "708-891-2004"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2060 RIVER OAKS DR",
"city": "CALUMET CITY",
"state": "IL",
"postal_code": "604095074",
"telephone_number": "708-891-2004"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SIVANESAN",
"first_name": "RENUKA",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-07-30",
"last_updated": "2009-07-30",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "IL",
"license": "046010288",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Calumet City, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.