Elk Grove Optical, P.C.

Primary specialty

OptometristTaxonomy code 152W00000X

License

046009854 Issued in IL

Legal business name

ELK GROVE OPTICAL, P.C.

Practice address

611 Meacham Rd
Elk Grove Village, IL 60007-3020

Phone

(847) 584-9900

Fax

(847) 584-9905

NPI assigned

Aug 26, 2008

Last updated

Aug 26, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Sung Y Kim

Title

Optometrist (O.D.)

Phone

(847) 584-9900

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1219708800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1219708800000",
    "number": "1447407085",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 MEACHAM RD",
            "city": "ELK GROVE VILLAGE",
            "state": "IL",
            "postal_code": "600073020",
            "telephone_number": "847-584-9900",
            "fax_number": "847-584-9905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 MEACHAM RD",
            "city": "ELK GROVE VILLAGE",
            "state": "IL",
            "postal_code": "600073020",
            "telephone_number": "847-584-9900",
            "fax_number": "847-584-9905"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELK GROVE OPTICAL, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-26",
        "last_updated": "2008-08-26",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "SUNG",
        "authorized_official_middle_name": "Y",
        "authorized_official_title_or_position": "OPTOMETRIST (O.D.)",
        "authorized_official_telephone_number": "847-584-9900"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046009854",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elk Grove Imaging Associates, S.C.
• Elk Grove Internal Medicine Associates, S.C.
• Elk Grove Lab Physicians, P.C.
• Elk Grove Medical Associates, LLC
• Elk Grove MRI Inc. (MRI Professionals of Elk Grove)
• Elk Grove Radiology
• Elk Grove Radiology S.C.
• Elk Grove SLF, LLC
• Elk Grove Smile Center, LLC
• Elk Grove Village Associates, LLP (Alexian Village of Elk Grove)

• Optometrist in Elk Grove Village, IL
• Providers in Elk Grove Village, IL by specialty
• Optometrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.