NPIMap

Organization Active NPI

Marengo Vision Center, P.C.

Doing business as Harvard Family Eye Care

  • Optometrist
  • Harvard, IL
National Provider Identifier
1396940938
Registry record updated Apr 18, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
046-009334 Issued in IL
Legal business name
MARENGO VISION CENTER, P.C.
Doing business as
Harvard Family Eye Care
Practice address
313 N Division St
Harvard, IL 60033-3060
Phone
(815) 943-6635
NPI assigned
Jun 15, 2007
Last updated
Apr 18, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2013

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

Authorized official

Name
Dr. Michael W. Thomas, O.D.NPI 1679539993
Title
President
Phone
(815) 568-6508

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 046-009334 IL Primary

Addresses

Primary practice location

313 N Division St
Harvard, IL 60033-3060

Mailing address

313 N Division St
Harvard, IL 60033-3060
Phone (815) 943-6635

Other names 1

  • Harvard Family Eye Care Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060724000159 IL Part B Supplier - Clinic/Group Practice 8426061169 Receives reassigned benefits from 4 practitioners
1 other NPI on this enrollment
Practice locations: Harvard, IL; Johnsburg, IL; Marengo, IL

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Harvard Family Eye Care2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

205 N State St
Marengo, IL 60152
Phone (815) 568-6508

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1181865600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1366243200000",
    "number": "1396940938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "313 N DIVISION ST",
            "city": "HARVARD",
            "state": "IL",
            "postal_code": "600333060",
            "telephone_number": "815-943-6635"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "313 N DIVISION ST",
            "city": "HARVARD",
            "state": "IL",
            "postal_code": "600333060",
            "telephone_number": "815-943-6635"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARENGO VISION CENTER, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-15",
        "last_updated": "2013-04-18",
        "status": "A",
        "authorized_official_last_name": "THOMAS",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "W.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "815-568-6508",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046-009334",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Harvard Family Eye Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Harvard, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2013; 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.