NPIMap

Organization Active NPI

Retina Institute of Illinois PC

  • Ophthalmology Physician
  • Niles, IL
National Provider Identifier
1417037623
Registry record updated Jun 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
RETINA INSTITUTE OF ILLINOIS PC
Practice address
8780 W Golf Rd
Suite 304
Niles, IL 60714-5602
Phone
(847) 297-8900
Fax
(847) 297-8926
NPI assigned
Oct 16, 2006
Last updated
Jun 18, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2025

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

Authorized official

Name
Candice B Davis
Title
Chief Revenue Cycle Officer
Phone
(916) 990-7590

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207W00000X Primary

Addresses

Primary practice location

8780 W Golf Rd
Suite 304
Niles, IL 60714-5602

Mailing address

8780 W Golf Rd
Suite 304
Niles, IL 60714-5602
Phone (847) 297-8900

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061205000398 IL Part B Supplier - Clinic/Group Practice 1153320973 Receives reassigned benefits from 10 practitioners
Practice locations: Oak Park, IL; Crystal Lake, IL; Niles, IL; Lombard, IL; Hoffman Estates, IL; Gurnee, IL; Chicago, IL; Huntley, IL

National Provider Directory

National Provider Directory
Tax ID family
Reitna Institute of Illinois2 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

2326 W Foster Ave
Chicago, IL 60625

2326 W Foster Ave
Ste 100
Chicago, IL 60625
Phone (773) 784-9400

820 E Terra Cotta Ave
Ste 245
Crystal Lake, IL 60014

820 E Terra Cotta Ave
Ste 247
Crystal Lake, IL 60014
Phone (815) 788-1000

1435 N Randall Rd
Ste 401
Elgin, IL 60123
Phone (630) 424-9877

36100 N Brookside Dr
Ste 105
Gurnee, IL 60031
Phone (847) 855-8142

36100 N Brookside Dr
Ste 206
Gurnee, IL 60031
Phone (847) 855-2500

6440 Grand Ave
Ste 102
Gurnee, IL 60031
Phone (847) 549-0863

1585 N Barrington Rd
Ste 404
Hoffman Estates, IL 60169
Phone (847) 755-9393

1585 N Barrington Rd
Ste 504
Hoffman Estates, IL 60169
Phone (847) 310-8100

12030 Princeton Dr
Huntley, IL 60142
Phone (815) 788-1000

Interoperability endpoints

  • Direct secure messaging: hle@retinaii.intellechartdirect.net
  • Direct secure messaging: jmichael@retinaii.intellechartdirect.net
  • Direct secure messaging: mpaxhia@retinaii.intellechartdirect.net
  • Direct secure messaging: mwessel@retinaii.intellechartdirect.net
  • Direct secure messaging: rrao@retinaii.intellechartdirect.net

Practitioners & affiliated clinicians

Practitioners 15

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.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1160956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1750204800000",
    "number": "1417037623",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8780 W GOLF RD",
            "address_2": "SUITE 304",
            "city": "NILES",
            "state": "IL",
            "postal_code": "607145602",
            "telephone_number": "847-297-8900",
            "fax_number": "847-297-8926"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8780 W GOLF RD",
            "address_2": "SUITE 304",
            "city": "NILES",
            "state": "IL",
            "postal_code": "607145602",
            "telephone_number": "847-297-8900",
            "fax_number": "847-297-8926"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RETINA INSTITUTE OF ILLINOIS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-16",
        "last_updated": "2025-06-18",
        "certification_date": "2025-06-18",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "CANDICE",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "CHIEF REVENUE CYCLE OFFICER",
        "authorized_official_telephone_number": "916-990-7590"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Niles, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2025; 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.