Homer Glen Vision Source LLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

046-006455 Issued in IL

Legal business name

HOMER GLEN VISION SOURCE LLC

Practice address

15933 S Bell Rd
Homer Glen, IL 60491-6707

Phone

(708) 301-3101

Fax

(708) 301-3141

NPI assigned

Nov 13, 2009

Organization subpart

No

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

Authorized official

Name

John J. Gardner, O.D.NPI 1700942539

Title

Sole Manager

Phone

(708) 301-3101

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 6

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

• John J. Gardner, O.D.

  • Optometrist
  • Hickory Hills, IL
  • NPI 1700942539
  Medicare reassignment Care Compare group NPD Authorized official
• Maliha Asadullah, OD

  • Optometrist
  • Hickory Hills, IL
  • NPI 1649002304
  Medicare reassignment Care Compare group NPD
• Dana Devito, OD

  • Optometrist
  • Naperville, IL
  • NPI 1669256350
  Medicare reassignment NPD
• Kimberly M Garvey, O.D.

  • Optometrist
  • Hickory Hills, IL
  • NPI 1831571140
  Medicare reassignment NPD
• Rohit K Sharma, O.D.

  • Optometrist
  • Orland Park, IL
  • NPI 1245468883
  Medicare reassignment NPD
• Cailyn Strupek, OD

  • Optometrist
  • Alexandria, VA
  • NPI 1851077440

  IL

  Medicare reassignment NPD

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

{
    "created_epoch": "1258070400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1258070400000",
    "number": "1437486362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15933 S BELL RD",
            "city": "HOMER GLEN",
            "state": "IL",
            "postal_code": "604916707",
            "telephone_number": "708-301-3101",
            "fax_number": "708-301-3141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15933 S BELL RD",
            "city": "HOMER GLEN",
            "state": "IL",
            "postal_code": "604916707",
            "telephone_number": "708-301-3101",
            "fax_number": "708-301-3141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOMER GLEN VISION SOURCE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-11-13",
        "last_updated": "2009-11-13",
        "status": "A",
        "authorized_official_last_name": "GARDNER",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "SOLE MANAGER",
        "authorized_official_telephone_number": "708-301-3101",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046-006455",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Home Hemo Dialysis Network LLC
• Homer Chiropractic Clinic LLC
• Homer Glen Chiropractic Center, SC
• Homer Glen Open MRI and Imaging LLC
• Homer Glen Pediatrics, SC
• Homer-Lockport Dental Associates, Inc.
• Marshelle Hood, LPC
• Hope and Prosper
• Hope for Recovery Inc
• Roseann M Horan, MD

• Optometrist in Homer Glen, IL
• Providers in Homer Glen, IL by specialty
• Optometrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2009; 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.