Lebanon Optometric Center, LLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

046007516 Issued in IL

Legal business name

LEBANON OPTOMETRIC CENTER, LLC

Doing business as

Lebanon Optometric Center

Practice address

201 W Saint Louis St
Lebanon, IL 62254-1515

Phone

(618) 537-6356

Fax

(618) 537-6358

NPI assigned

Apr 7, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Charissa Thorpe, O.D.NPI 1740225994

Title

Owner

Phone

(618) 537-6356

Specialties & licenses 1

Addresses

Other names 2

• Lebanon Optometric Center Doing business as
• Robert J Klinsky & Charissa L Thorpe, PTR Former legal business name

Medicare fee-for-service enrollment

Enrolled in IL2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

Practitioners 4

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

• Charissa Lee Thorpe, O.D.

  • Optometrist
  • Lebanon, IL
  • NPI 1740225994
  Medicare reassignment Care Compare group NPD Authorized official
• Justin Groennert, O.D.

  • Optometrist
  • Lebanon, IL
  • NPI 1083230585
  Medicare reassignment Care Compare group NPD
• Claire M Klinsky, O.D.

  • Optometrist
  • Lebanon, IL
  • NPI 1508121344
  Medicare reassignment Care Compare group NPD
• Robert Joseph Klinsky, O.D.

  • Optometrist
  • Lebanon, IL
  • NPI 1568407716
  Medicare reassignment NPD

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

{
    "created_epoch": "1175904000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583452800000",
    "number": "1447373378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 W SAINT LOUIS ST",
            "city": "LEBANON",
            "state": "IL",
            "postal_code": "622541515",
            "telephone_number": "618-537-6356",
            "fax_number": "618-537-6358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 W SAINT LOUIS ST",
            "city": "LEBANON",
            "state": "IL",
            "postal_code": "622541515",
            "telephone_number": "618-537-6356",
            "fax_number": "618-537-6358"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "103 N Pearl St",
            "address_purpose": "LOCATION",
            "city": "Lebanon",
            "state": "IL",
            "postal_code": "622541511",
            "country_code": "US",
            "telephone_number": "618-537-6356",
            "fax_number": "618-537-6358",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LEBANON OPTOMETRIC CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-07",
        "last_updated": "2020-03-06",
        "certification_date": "2020-03-06",
        "status": "A",
        "authorized_official_last_name": "THORPE",
        "authorized_official_first_name": "CHARISSA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "618-537-6356",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046007516",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lebanon Optometric Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lebanon Optometric Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Robert J Klinsky & Charissa L Thorpe, PTR",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Lebanon Chiropractic Clinic PC
• Lebanon Community Unit School District 9
• Lebanon Hco, LLC
• Lebanon Hco, LLC
• Lebanon Healthcare LLC
• Lebanon Terrace
• Abigail Maurer, ATC
• Jennifer Meyer, M.S., CCC-SLP
• Lucas Ray Moake
• Ashlei L Moses

• Optometrist in Lebanon, IL
• Providers in Lebanon, IL by specialty
• Optometrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.