Reenvision Eyecare, S.C.

Primary specialty

Cornea and External Diseases Specialist PhysicianTaxonomy code 207WX0120X

Legal business name

REENVISION EYECARE, S.C.

Practice address

355 W Dundee Rd # Suie110
Buffalo Grove, IL 60089-3500

Phone

(847) 541-4878

Fax

(847) 520-0500

NPI assigned

Aug 23, 2021

Organization subpart

No

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

Authorized official

Name

Kristi Lyn Kozlov, MDNPI 1750443073

Title

Owner

Phone

(312) 771-2007

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Practitioners 1

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

• Kristi Lyn Kozlov, LLC

  • Ophthalmology Physician
  • Lisle, IL
  • NPI 1750443073
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1629676800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629676800000",
    "number": "1386311900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "355 W DUNDEE RD # SUIE110",
            "city": "BUFFALO GROVE",
            "state": "IL",
            "postal_code": "600893500",
            "telephone_number": "847-541-4878",
            "fax_number": "847-520-0500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "355 W DUNDEE RD # SUIE110",
            "city": "BUFFALO GROVE",
            "state": "IL",
            "postal_code": "600893500",
            "telephone_number": "847-541-4878",
            "fax_number": "847-520-0500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REENVISION EYECARE, S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-23",
        "last_updated": "2021-08-23",
        "certification_date": "2021-08-23",
        "status": "A",
        "authorized_official_last_name": "KOZLOV",
        "authorized_official_first_name": "KRISTI",
        "authorized_official_middle_name": "LYN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "312-771-2007",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207WX0120X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology, Cornea and External Diseases Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Cornea and External Diseases Specialist Physician in Buffalo Grove, IL
• Providers in Buffalo Grove, IL by specialty
• Cornea and External Diseases Specialist Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2021; 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.