Individual provider Active NPI

Mariah Sandy

  • Optometrist
  • Chicago, IL
National Provider Identifier
1447062294
Registry record updated Sep 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
046.011945 Issued in IL
Practice address
111 N State St
Chicago, IL 60602-1659
Phone
(312) 634-9535
NPI assigned
Jan 20, 2025
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 23, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 046.011945 IL Primary

Addresses

Primary practice location

111 N State St
Chicago, IL 60602-1659

Mailing address

111 N State St
Chicago, IL 60602-1659

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
I20250528002304 IL Practitioner - Optometry 3375062870 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Pennsylvania College of Optometry, 2024
Medicare assignment
May accept Medicare assignment
Group practices
Chander Vision Group LTDGroup PAC ID 4789640020, 2 clinicians

Practice addresses (Care Compare)

5460 S Archer Ave
Chicago, IL 60638-3033
Phone (773) 735-6090

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
046.011945ILMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Chander Vision Group LTD Optometrist CurrentSince Mar 25, 2025 Accepting new patients

Locations

5460 S Archer Ave
Chicago, IL 60638
Phone (773) 735-6090

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1737331200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758585600000",
    "number": "1447062294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 N STATE ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606021659"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 N STATE ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606021659",
            "telephone_number": "312-634-9535"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANDY",
        "first_name": "MARIAH",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-01-20",
        "last_updated": "2025-09-23",
        "certification_date": "2025-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046.011945",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.