Individual provider Active NPI

Avjit Shahi

  • Optometrist
  • Oswego, IL
National Provider Identifier
1396123386
Registry record updated Aug 31, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
046011058 Issued in IL
Practice address
83 Templeton Dr Ste F
Oswego, IL 60543-7025
Phone
(630) 554-8002
Fax
(630) 554-8095
NPI assigned
May 11, 2015
Last updated
Aug 31, 2020By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 31, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 046011058 IL Primary

Addresses

Primary practice location

83 Templeton Dr Ste F
Oswego, IL 60543-7025

Mailing address

83 Templeton Dr
Ste F
Oswego, IL 60543-7025

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20161005002965 IL Practitioner - Optometry 1759679814 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Oswego Vision LTDGroup PAC ID 5496773103, 3 clinicians

Practice addresses (Care Compare)

83 Templeton Dr
Suite F
Oswego, IL 60543-7025
Phone (630) 554-8002

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
046011058ILMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Oswego Vision, LTD Optometrist CurrentSince Mar 1, 2020 Accepting new patients

Locations

83 Templeton Dr
Ste F
Oswego, IL 60543
Phone (630) 554-8002

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1431302400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598832000000",
    "number": "1396123386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "83 TEMPLETON DR",
            "address_2": "STE F",
            "city": "OSWEGO",
            "state": "IL",
            "postal_code": "605437025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "83 TEMPLETON DR STE F",
            "city": "OSWEGO",
            "state": "IL",
            "postal_code": "605437025",
            "telephone_number": "630-554-8002",
            "fax_number": "630-554-8095"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAHI",
        "first_name": "AVJIT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-05-11",
        "last_updated": "2020-08-31",
        "certification_date": "2020-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046011058",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oswego, IL

Sources for this page

Verify at the official NPI Registry.